Infant Antibiotic Resistance and Implications for Therapeutic Decision-making
Infant Antibiotic Resistance and Implications for Therapeutic Decision-making
Escalating resistance to antibiotics among disease-causing community bacteria increasingly
 threatens our ability to treat patients' infections. At the level of the physician-patient
 encounter, incentives at the patient level often take priority to society; this is often the
 case with antibiotic prescribing. Each patient level antibiotic treatment decision is based
 on how we value potential outcomes, including short-term benefits and risks and longer-term
 risks, including those related to future bacterial resistance to antibiotics. Unfortunately,
 antibiotics are often prescribed for illnesses unlikely to have a bacterial etiology; even a
 very small likelihood of benefit seems to outweigh an increased risk of future antibiotic
 resistance. While short-term effects of antibiotics on colonization with resistant bacteria
 have been demonstrated, the overall implications of each treatment for future individual,
 family and societal-level resistance remain difficult to quantify, and are often steeply
 discounted or ignored during decision-making. Knowledge regarding the longer-term effects of
 personal and household antibiotic use could better quantify these future resistance-related
 risks, and help guide antibiotic decision-making for physicians and patients.

 Infants are born with sterile nasopharyngeal and gastrointestinal tracts and yet, during the
 1st year of life, become important reservoirs of resistant organisms; this creates an
 opportunity to study colonization and resistance starting from a microbiological tabula rasa.
 In this proposal, we will use an observational cohort to following newborns' antibiotic
 exposure and longitudinal colonization with specific bacterial pathogens and related
 antibiotic resistance in the 1st year of life. Our hypothesis is that during the 1st year of
 life, infants with personal and household antibiotic exposure will have greater colonization
 with resistan organisms than infants without antibiotic exposure. This project will help us
 understand the development of bacteria that are resistant to antibiotics within the
 community, and help to inform judicious decision-making regarding antibiotic prescribing.
Inclusion Criteria:

 -  Infant in regular nursery at University Hospitals CWRU

 -  Mother has legal custody

 -  Mother is >=18 years old

 -  Mother's and baby's physicians have granted permission for possible enrollment

 -  Mother speaks, reads and understands the English language

 Exclusion Criteria:

 -  Does not fit inclusion criteria