{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T12:20:35Z","timestamp":1772194835747,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2016,9,24]]},"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antibiotic resistance is a worldwide problem. We describe 25\u2005years of responsible antibiotic use in a tertiary neonatal unit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data on neonatal infections and antibiotic use were collected prospectively from 1990 to 2014 at a single tertiary Sydney neonatal intensive care unit attached to a maternity unit. There are approximately 5500 deliveries and 900 nursery admissions per year.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean annual rate of late-onset sepsis was 1.64 episodes per 100 admissions. The mean number of late-onset sepsis episodes per admission to the neonatal unit decreased by 4.0% per year (95% CI 2.6% to 5.4%; p&lt;0.0001) and occurred particularly in infants born weighing &lt;1500\u2005g. No infants with negative cultures relapsed with sepsis when antibiotics were stopped after 48\u201372\u2005hours. Antibiotic use decreased with time. The proportion of colonising methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> isolates decreased by 7.4% per year (95% CI 0.2% to 14.1%; p=0.043). The proportion of colonising Gram-negative bacilli isolates resistant to either third-generation cephalosporins or gentamicin increased by 2.9% per year (95% CI 1.0% to 4.9%; p=0.0035). Most were cephalosporin-resistant; gentamicin resistance was rare. An average of one baby per year died from late-onset sepsis, the rate not varying significantly over time. The mortality from episodes of late-onset sepsis was 25 of 332 (7.5%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Stopping antibiotics after 2\u20133\u2005days if neonatal systemic cultures are negative is safe. However, it does not prevent the emergence of cephalosporin-resistant Gram-negative organisms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2016-310905","type":"journal-article","created":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T22:55:04Z","timestamp":1476399304000},"page":"F244-F250","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Effect of antibiotic use on antimicrobial antibiotic resistance and late-onset neonatal infections over 25\u2005years in an Australian tertiary neonatal unit"],"prefix":"10.1136","volume":"102","author":[{"given":"David","family":"Carr","sequence":"first","affiliation":[{"name":"Junior Medical Staff Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth Helen","family":"Barnes","sequence":"additional","affiliation":[{"name":"NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne","family":"Gordon","sequence":"additional","affiliation":[{"name":"RPA Newborn Care, John Spence Neonatal Nursery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,10,13]]},"reference":[{"key":"2025090510442634000_102.3.F244.1","doi-asserted-by":"crossref","unstructured":"Isaacs D . 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