@article {CarrF244, author = {David Carr and Elizabeth Helen Barnes and Adrienne Gordon and David Isaacs}, title = {Effect of antibiotic use on antimicrobial antibiotic resistance and late-onset neonatal infections over 25 years in an Australian tertiary neonatal unit}, volume = {102}, number = {3}, pages = {F244--F250}, year = {2017}, doi = {10.1136/archdischild-2016-310905}, publisher = {BMJ Publishing Group}, abstract = {Background Antibiotic resistance is a worldwide problem. We describe 25 years of responsible antibiotic use in a tertiary neonatal unit.Methods 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.Results 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\<0.0001) and occurred particularly in infants born weighing \<1500 g. No infants with negative cultures relapsed with sepsis when antibiotics were stopped after 48{\textendash}72 hours. Antibiotic use decreased with time. The proportion of colonising methicillin-resistant Staphylococcus aureus 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\%).Conclusion Stopping antibiotics after 2{\textendash}3 days if neonatal systemic cultures are negative is safe. However, it does not prevent the emergence of cephalosporin-resistant Gram-negative organisms.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/102/3/F244}, eprint = {https://fn.bmj.com/content/102/3/F244.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }