A Neonatal Unit Experience with Empiric Antibiotics for Late-onset Neonatal Sepsis: A Retrospective Study

Neonatal sepsis remains a major cause of morbidity and mortality and warrants the immediate start of appropriate empiric treatment. Thus, this study compared the effectiveness of the 2 antibiotic regimens (cloxacillin–amikacin or cefotaxime–ampicillin) among neonates with late-onset neonatal sepsis. METHODS: We conducted a retrospective cohort study comparing mortality between 2 treatment cohorts of very low birth weight neonates with late-onset sepsis, who had received amikacin–cloxacillin or cefotaxime–ampicillin between January 2014 and December 2017. There were 27 neonates in each treatment arm after 1:1 propensity score matching. Univariate analyses (Chi-square and independent t tests, where appropriate) were performed to determine the association between variables. We determined the hazard ratio for all-cause mortality using the Cox regression model. RESULTS: We identified a total of 132 neonates from the hospital’s record. We included 27 neonates each in the amikacin–cloxacillin and cefotaxime–ampicillin groups. Intraventricular hemorrhage, necrotizing enterocolitis, birth weight, and gestational age were significantly associated with mortality (P < 0.05). The risk of mortality was significantly higher in neonates receiving empiric cefotaxime and ampicillin than those receiving amikacin and cloxacillin (hazard ratio: 2.91, 95% confidence interval: 1.17–7.30, P = 0.023). CONCLUSIONS: In our center, amikacin–cloxacillin combination therapy was associated with lower mortality in very low birth weight neonates with late-onset sepsis compared with cefotaxime–ampicillin therapy.