{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T17:50:37Z","timestamp":1758477037064,"version":"3.40.5"},"reference-count":28,"publisher":"American Academy of Pediatrics (AAP)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,1]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To assess hospital differences in empirical antibiotic use, bacterial epidemiology, and antimicrobial susceptibility for common antibiotic regimens among young infants with urinary tract infection (UTI), bacteremia, or bacterial meningitis.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We reviewed medical records from infants &lt;90 days old presenting to 8 US children\u2019s hospitals with UTI, bacteremia, or meningitis. We used the Pediatric Health Information System database to identify cases and empirical antibiotic use and medical record review to determine infection, pathogen, and antimicrobial susceptibility patterns. We compared hospital-level differences in antimicrobial use, pathogen, infection site, and antimicrobial susceptibility.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n We identified 470 infants with bacterial infections: 362 (77%) with UTI alone and 108 (23%) with meningitis or bacteremia. Infection type did not differ across hospitals (P = .85). Empirical antibiotic use varied across hospitals (P &lt; .01), although antimicrobial susceptibility patterns for common empirical regimens were similar. A third-generation cephalosporin would have empirically treated 90% of all ages, 89% in 7- to 28-day-olds, and 91% in 29- to 89-day-olds. The addition of ampicillin would have improved coverage in only 4 cases of bacteremia and meningitis. Ampicillin plus gentamicin would have treated 95%, 89%, and 97% in these age groups, respectively.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Empirical antibiotic use differed across regionally diverse US children\u2019s hospitals in infants &lt;90 days old with UTI, bacteremia, or meningitis. Antimicrobial susceptibility to common antibiotic regimens was similar across hospitals, and adding ampicillin to a third-generation cephalosporin minimally improves coverage. Our findings support incorporating empirical antibiotic recommendations into national guidelines for infants with suspected bacterial infection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2016-0162","type":"journal-article","created":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T08:35:20Z","timestamp":1501576520000},"page":"427-435","source":"Crossref","is-referenced-by-count":10,"title":["Empiric Antibiotic Use and Susceptibility in Infants With Bacterial Infections: A Multicenter Retrospective Cohort Study"],"prefix":"10.1542","volume":"7","author":[{"given":"Elana A.","family":"Feldman","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell J.","family":"McCulloh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Children\u2019s Mercy, University of Missouri\u2013Kansas City School of Medicine, Kansas City, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela L.","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Children\u2019s Mercy, University of Missouri\u2013Kansas City School of Medicine, Kansas City, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda C.","family":"Bradford","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research, Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth R.","family":"Alpern","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Balamuth","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and Division of Emergency Medicine, Department of Pediatrics, The Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercedes M.","family":"Blackstone","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and Division of Emergency Medicine, Department of Pediatrics, The Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whitney L.","family":"Browning","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Hayes","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and Division of Emergency Medicine, Department of Pediatrics, The Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalynne","family":"Korman","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rianna C.","family":"Leazer","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Children\u2019s Hospital of The King\u2019s Daughters, Norfolk, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Marble","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Roben","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel S.","family":"Tieder","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research, Seattle Children\u2019s Hospital, Seattle, Washington;"},{"name":"Division of Hospital Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2017,8,1]]},"reference":[{"issue":"205","key":"2021120817251314600_B1","first-page":"1","article-title":"Diagnosis and management of febrile infants (0\u20133 months)","author":"Hui","year":"2012","journal-title":"Evid Rep Technol Assess (Full Rep)"},{"issue":"11","key":"2021120817251314600_B2","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1097\/CCM.0000000000000509","article-title":"Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis","volume":"42","author":"Weiss","year":"2014","journal-title":"Crit Care Med"},{"issue":"1","key":"2021120817251314600_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-0127","article-title":"Costs and infant outcomes after implementation of a care process model for febrile infants","volume":"130","author":"Byington","year":"2012","journal-title":"Pediatrics"},{"issue":"6","key":"2021120817251314600_B4","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1542\/peds.113.6.1662","article-title":"Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections","volume":"113","author":"Byington","year":"2004","journal-title":"Pediatrics"},{"issue":"20","key":"2021120817251314600_B5","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199311113292001","article-title":"Outpatient management without antibiotics of fever in selected infants","volume":"329","author":"Baker","year":"1993","journal-title":"N Engl J Med"},{"issue":"3","key":"2021120817251314600_B6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S0022-3476(89)80831-5","article-title":"Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis","volume":"115","author":"Dagan","year":"1989","journal-title":"J Pediatr"},{"issue":"2","key":"2021120817251314600_B7","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s40272-015-0161-1","article-title":"Optimizing the use of antibacterial agents in the neonatal period","volume":"18","author":"Cantey","year":"2016","journal-title":"Paediatr Drugs"},{"issue":"2","key":"2021120817251314600_B8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s40272-013-0017-5","article-title":"Pharmacokinetics of antibacterial agents in the CSF of children and adolescents","volume":"15","author":"Sullins","year":"2013","journal-title":"Paediatr Drugs"},{"issue":"4","key":"2021120817251314600_B9","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1542\/hpeds.2015-0187","article-title":"A meta-analysis of the rates of Listeria monocytogenes and Enterococcus in febrile infants","volume":"6","author":"Leazer","year":"2016","journal-title":"Hosp Pediatr"},{"issue":"6","key":"2021120817251314600_B10","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1542\/hpeds.2014-0121","article-title":"Epidemiology of bacteremia in previously healthy febrile infants: a follow-up study","volume":"5","author":"Mischler","year":"2015","journal-title":"Hosp Pediatr"},{"key":"2021120817251314600_B11","unstructured":"The White House. National Action Plan for Combating Antibiotic-Resistant Bacteria. Published March 2015 Available at: https:\/\/obamawhitehouse.archives.gov\/sites\/default\/files\/docs\/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf Accessed June 1, 2017"},{"issue":"6","key":"2021120817251314600_B12","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/jhm.2329","article-title":"Association of clinical practice guidelines with emergency department management of febrile infants \u226456 days of age","volume":"10","author":"Aronson","year":"2015","journal-title":"J Hosp Med"},{"issue":"12","key":"2021120817251314600_B13","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1002\/jhm.2441","article-title":"Accuracy of diagnosis codes to identify febrile young infants using administrative data","volume":"10","author":"Aronson","year":"2015","journal-title":"J Hosp Med"},{"key":"2021120817251314600_B14","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"issue":"2","key":"2021120817251314600_B15","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1542\/peds.2013-0179","article-title":"Variation in emergency department diagnostic testing and disposition outcomes in pneumonia","volume":"132","author":"Florin","year":"2013","journal-title":"Pediatrics"},{"issue":"2","key":"2021120817251314600_B16","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"3","key":"2021120817251314600_B17","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1542\/peds.2011-1330","article-title":"Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months","volume":"128","author":"Roberts","year":"2011","journal-title":"Pediatrics"},{"issue":"8","key":"2021120817251314600_B18","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/j.1440-1754.2012.02449.x","article-title":"Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study","volume":"48","author":"Tosif","year":"2012","journal-title":"J Paediatr Child Health"},{"key":"2021120817251314600_B19","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing. 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