Epidemiological Evaluation of Blood Culture Patterns among Neonates Receiving Vancomycin

Abstract

The objective of this study was to assess the frequency of blood culture (BC) collection among neonates who received vancomycin. Demographic, clinical, microbiologic, and pharmacy data were collected for 1275 neonates (postnatal age 0-27 days) who received vancomycin at an Intermountain Healthcare facility between 1/2006 and 9/2011. Neonates treated with vancomycin had a BC collected 94 % (n = 1198) of the time, of which 37 % (n = 448) grew one or more bacterial organisms (BC positive). Of these, 1 % (n = 5) grew methicillin-resistant Staphylococcus aureus (MRSA), 71 % (n = 320) grew coagulase-negative Staphylococci (CoNS), 9 % (n = 40) grew methicillin-sensitive Staphylococcus aureus (MSSA), and 22 % (n = 97) grew other bacterial species (total exceeds 100 % due to co-detection). In patients with negative BC or no BC, vancomycin therapy was extended beyond 72 h 52 % of the time. The median duration of vancomycin therapy for patients with a negative BC was 4 (IQR: 2-10) days. BCs were frequently obtained among neonates who received vancomycin. Vancomycin therapy beyond the conventional 'empiric' treatment window of 48-72 h was common without isolation of resistant grampositive bacteria.

Outcomes After Skin and Soft Tissue Infection in Infants 90 Days Old or Younger

“…Geographic variation in the incidence of MRSA infections have also been well described, [20][21][22] unlike other geographic areas, Utah did not experience a large increase in community-associated MRSA during the study period. 23,24 Unpublished 2014 internal Intermountain Healthcare laboratory data showed that MRSA wound culture rates in pediatric patients across the IH system were 28%, and 33% at the tertiary children' s hospital (K.K., unpublished observations). Unfortunately, inconsistent capture of wound cultures during the study period precluded analysis of this element in our study.…”

Adverse consequences of neonatal antibiotic exposure

“…Centers vary widely in use of antibiotics for neonates, [28*, 34, 35, 36]. In a recent survey of guidelines for use of 41 antimicrobials in French NICUs, 1 to 32 different dosing regimens per drug were identified.…”

Unanswered Questions Regarding Optimal Pediatric Vancomycin Use

“…We found that only 1% of neonates who received vancomycin had MRSA detected, which suggests that therapeutic drug monitoring and dosing adjustments may occur for a large number of children without evidence of MRSA. 10 As 71% of these neonates grew coagulase-negative Staphylococci, it is unknown whether an AUC 24 /MIC $400 or a trough concentration target of 10-15 or 15-20 mg/L (all of which were derived from studies of MRSA) is appropriate. Despite its discovery more than 50 years ago, many unanswered questions remain regarding the optimal use of vancomycin for pediatric populations.…”

“…[7][8][9] A generic formulation of EFV has recently been approved by European Medicines Agency (EMA) according to results of a bioequivalence study done in healthy volunteers. 10 However, evidence is available showing that this population may not adequately reflect what happens in HIV-infected patients in terms of antiretroviral drugs pharmacokinetics. 11,12 Moreover, the single-dose cross-over design, adopted in bioequivalence studies, is a condition far from the real-life scenario.…”