A national survey of first line antibiotic use in neonatal units - and the potential scope for iatrogenic sensorineural hearing loss prevention.

IF 2.1 3区 医学 Q2 PEDIATRICS Frontiers in Pediatrics Pub Date : 2024-10-29 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1471463
J Peterson, L Muddiman, F Groves, N Booth, W G Newman, J H McDermott, A Mahaveer
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Abstract

Objective: National Institute for Clinical Excellence (NICE) guidance for the management of neonatal sepsis recommends a first-line antibiotic regimen containing an aminoglycoside (gentamicin). Aminoglycoside exposure causes sensorineural hearing loss in individuals with a specific mitochondrial genetic variant (m.1555A>G). This variant can be detected promptly (in <30 min) by a point of care test. NICE does allow for variation in antibiotic regimes depending on local microbiology guidance. As practices can vary, this survey aimed to determine the current use of first-line antibiotic agents within neonatal units and postnatal wards across the UK.

Design and setting: A telephone survey was conducted across all neonatal units in the United Kingdom. Responses were requested from a member of the neonatal team experienced in neonatal septic screening processes. One response was recorded per unit.

Results: Of the 187 neonatal units, 186 (99%) responded to the survey. One unit declined to participate. The survey results show most neonatal units (93%) and postnatal wards (74%) across the United Kingdom use aminoglycosides as first-line antibiotic agents. Antibiotic regimes varied between different units and between different locations within the same hospital (NICU vs. postnatal wards). In cases where there was a contraindication to aminoglycosides, the most common alternative antibiotic was cefotaxime.

Conclusions: Most neonatal units in the UK use an aminoglycoside antibiotic as first-line agent for suspected sepsis. This places infants with the m.1555A>G genetic variant at risk of iatrogenic hearing loss. There needs to be integration of point-of-care genetic testing within the neonatal septic screening pathway.

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新生儿病房一线抗生素使用情况全国调查--以及预防先天性感音神经性听力损失的潜在范围。
目的:美国国家临床优化研究所(NICE)关于新生儿败血症治疗的指导建议采用含有氨基糖苷(庆大霉素)的一线抗生素治疗方案。接触氨基糖苷类药物会导致具有特定线粒体基因变异(m.1555A>G)的个体出现感音神经性听力损失。这种变异可被及时发现(在设计和环境中):对英国所有新生儿科室进行了电话调查。要求一名在新生儿败血症筛查过程中经验丰富的新生儿团队成员进行回复。每个单位记录一个回复:结果:在 187 个新生儿科室中,有 186 个(99%)对调查做出了回复。一个单位拒绝参与。调查结果显示,英国大部分新生儿科室(93%)和产后病房(74%)将氨基糖苷类药物作为一线抗生素。不同单位和同一医院不同地点(新生儿重症监护室与产后病房)的抗生素方案各不相同。在禁用氨基糖苷类药物的情况下,最常用的替代抗生素是头孢他啶:结论:英国大多数新生儿科室将氨基糖苷类抗生素作为治疗疑似败血症的一线药物。这使得m.1555A>G基因变异的婴儿面临先天性听力损失的风险。在新生儿败血症筛查过程中,需要整合护理点基因检测。
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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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