# Use of RESERVE-Antibiotics in Newborns: Clinical Experience of Two NICUs in the Metropolitan Area of Palermo

## TL;DR

This paper discusses the use of last-resort antibiotics in newborns in two NICUs in Palermo, highlighting the challenges of treating antibiotic-resistant infections.

## Contribution

The study presents clinical experiences with RESERVE antibiotics in neonatal care, contributing to limited evidence on their use in newborns.

## Key findings

- Four newborn patients were treated with last-generation antibiotics over three years.
- The use of these antibiotics is increasing due to multidrug-resistant organisms causing sepsis.
- Standardized treatment approaches are needed for neonatal antibiotic-resistant infections.

## Abstract

Background: The increasingly indiscriminate use of antibiotic therapy in the neonatal period has led to the emergence of multidrug-resistant organisms (MDROs), which are responsible for sepsis that is increasingly difficult to treat and associated with high morbidity and mortality. Increasingly frequently, in neonatal intensive care units (NICUs), it is necessary to use last-generation antibiotics belonging to the RESERVE group according to the current classification of the World Health Organization (WHO). Methods: Among these drugs, ceftazidime-avibactam, ceftolozane-tazobactam and meropenem-vaborbactam are increasingly used in infections caused by Enterobacterales (i.e., E. cloacae complex, Klebsiella spp.), which are often responsible for late-onset sepsis (LOS) in newborns, especially in preterms. Results: Here, we present the experience of four newborn patients in the city of Palermo, treated over a period of 3 years. Conclusions: The comparison between different diagnostic–therapeutic management approaches and a review of the most recent literature can contribute to identifying more standardized pharmacological schemes, especially in the neonatal period, where scientific evidence about this topic is still very limited.