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

<b>Background</b>: 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). <b>Methods</b>: Among these drugs, ceftazidime-avibactam, ceftolozane-tazobactam and meropenem-vaborbactam are increasingly used in infections caused by Enterobacterales (i.e., <i>E. cloacae complex</i>, <i>Klebsiella</i> spp.), which are often responsible for late-onset sepsis (LOS) in newborns, especially in preterms. <b>Results</b>: Here, we present the experience of four newborn patients in the city of Palermo, treated over a period of 3 years. <b>Conclusions</b>: 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.