A Seven-Year Survey of Management of Coagulase-Negative Staphylococcal Sepsis in the Neonatal Intensive Care Unit: Vancomycin May Not Be Necessary as Empiric Therapy

Abstract

Background: The typical empiric therapy for coagulase-negative staphylococcal (CONS) sepsis includes vancomycin. In our neonatal intensive care unit, we have consistently avoided the use of vancomycin to treat CONS sepsis, except for specific cases, and have used instead cefazolin as empiric agent. Objectives: The clinical outcome of infants with CONS sepsis was evaluated in relation to the susceptibility of CONS blood isolates to cefazolin over a period of 7 years. Methods: Clinical characteristics, symptoms of sepsis and antibiotic use were studied retrospectively. Susceptibility of CONS blood isolates to cefazolin was determined by E-test. Results: Of 163 infants with proven CONS sepsis, 121/140 (86%) infants with a cefazolin-susceptible (minimum inhibition concentration (MIC) ≤8 mg/l) and 21/23 (91%) with a cefazolin-resistant (MIC ≧32 mg/l) blood isolate were treated with cefazolin. 21 (13%) infants were switched to vancomycin, in only 3 of them CONS had become resistant to cefazolin. The majority (81%) of the infants with a good response to cefazolin had the indwelling central venous catheter removed, in contrast to only 22% of the infants with cefazolin treatment failure. Median cefazolin MIC values were 0.75–2 mg/l during the study period. Conclusions: The great majority of infants with CONS sepsis was successfully treated with cefazolin. The use of vancomycin could be restricted to specific cases. Despite the consistent use of cefazolin in neonatal CONS sepsis over an extended period of time, cefazolin MIC values remained low and in the susceptible range. Removal of the central venous catheter in infants with clinical symptoms of sepsis is an important therapeutic measure.

Pharmacokinetics of Prophylactic Cefazolin in Parturients Undergoing Cesarean Delivery

“…However, these studies were not designed to investigate antibacterial activity in neonates. Recently, cefazolin successfully treated a majority of infants with coagulase-negative staphylococcal sepsis in a neonatal intensive care unit (16). Our simulations indicate that therapeutic concentrations of free cefazolin are preserved in newborns for a minimum of 6 h, which may be clinically beneficial as a preventive treatment.…”

“…In contrast, transplacental passage of cefazolin may potentially decrease the incidence of neonatal sepsis. Cefazolin has recently been suggested as an effective alternative to vancomycin in the treatment of infants with coagulase-negative staphylococcal sepsis (16). However, there is no information on maternal dosing schemes to produce optimal safety and efficacy in neonates.…”

Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study

“…Cephalosporin exposure was associated with a decreased risk for CoNS-LOS, possibly due to the sensitivity of CoNS species to cephalosporins. Therefore, exposure to this agent could reduce the risk of invasion of CoNS from either the skin or the gut into the bloodstream [16, 17]. However, implementation of routine administration of cephalosporins in preterm infants remains a topic of debate mainly because of the increased risk for colonization with extended-spectrum β-lactamase producing bacteria [18].…”

Antibiotic Use in Newborns with Transient Tachypnea of the Newborn

“…In addition, unnecessary antibiotic use threatens the entire NICU population, as widespread use of ‘benign’ antibiotics creates selection pressure for drug-resistant organisms and pathogenic yeast in the hospital environment [8]. Antimicrobial stewardship is therefore an important priority for the neonatal care community [9,10,11,12]. …”