A Little Ceftriaxone Goes a Long Way: Third-Generation Cephalosporin Exposure and Risk of Subsequent Resistance among Potential AmpC Producers

Reviewed by Zach Willis, MD, MPH; University of North Carolina, Chapel Hill, NC

Stultz and colleagues analyzed urinary and respiratory isolates of possible AmpC producers (Citrobacter, Enterobacter, Morganella, Serratia) over a 5-year period at a single children’s hospital and assessed risk factors for resistance to third-generation cephalosporins (TGC). They found that exposure to TGC for greater than 48 hours in the prior 30 days was associated with an 8-fold greater odds of resistance to this class in these subsequent isolates; a separate ecologic analysis demonstrated decreasing rates of TGC resistance in these isolates as total TGC utilization declined in their hospital. The authors conclude that timely review of TGC orders within 48 hours with de-escalation where possible may reduce the risk of subsequent resistance, preserving the efficacy of TGC for empiric use. Overall, this study provides additional evidence of the potential harm of excess antibacterial spectrum and the potential benefit of targeted stewardship of third-generation cephalosporins in the pediatric population.


Stultz JS, Bice T, Johnstone K, et al. Importance of Reviewing Antibiotic Courses by 48 Hours: Risk Factors for Third-Generation Cephalosporin Resistance Among AmpC Harboring Organisms in Urine and Respiratory Cultures. Pediatr Infect Dis J. Published online December 1, 2020. doi:10.1097/INF.0000000000003006

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