Gram-negative bacteria infections in neonates using gastric acidity inhibitors drugs

Objectives & Study: There is evidence of an increased risk of infections in neonates treated with gastric acidity inhibitors (GAI)1,2,3. The aim of the study was to investigate the etiology of infections associated with the use of GAI in Very Low Birth Weight (VLBW) newborns. Methods: Multicenter prospective observational study was conducted on VLBW neonates with birth weight between 401- 1500 g or gestational age between 24 and 32 weeks, consecutively observed in Neonatal Intensive Care Unit. Information regarding the occurrence and microbiology of sepsis in subjects exposed or not exposed (controls) to treatment with gastric acidity inhibitors, were collected. Results: We evaluated 274 VLBW infants: 91 have taken ranitidine and 183 have not. The main clinical and demographic characteristics did not differ between the two groups. Occurrence of infections was significantly higher in the group exposed to treatment with gastric acidity inhibitors (OR 5.5, 95 % CI 2.9-10.4, p < 0.001). Gram-negative bacteria (Escherichia coli 10 vs.2, p < 0.001; Klebsiella pneumoniae 8 vs. 1, p = <0.001; Pseudomonas aeruginosa 6 vs. 1, p = < 0.006) were prevalent in neonates exposed to ranitidine compared to controls. Conclusion: The therapy with ranitidine in VLBW infants is associated with an increased risk of infections caused primarily by Gram-negative bacteria. Neonatologists need to consider this aspect in the antibiotic management of sepsis associated with the use of gastric acidity inhibitors.