BACKGROUND: Coagulase-negative Staphylococcus (CoNS) is the most common cause of bloodstream infections (BSI) in hospitalized infants. CoNS BSI is most reliably treated with vancomycin; however, concerns about side effects and promoting resistance often delay empirical vancomycin therapy until culture results become available. METHODS: All infants with CoNS BSI discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group from 1997 to 2012 were identified. Empirical vancomycin therapy was defined as vancomycin exposure on the day of the first positive blood culture. Delayed vancomycin therapy was defined as vancomycin exposure 1-3 days after the first positive blood culture. We used multivariable logistic regression with random effects for site to evaluate the association between the use of empirical vancomycin therapy versus delayed vancomycin therapy and 30-day mortality, controlling for gestational age, small-for-gestational age status, postnatal age on the day of the first positive culture, oxygen requirement, ventilator support and inotropic support on the day the first positive culture was obtained. RESULTS: A total of 4364 infants with CoNS BSI were identified; 2848 (65%) were treated with empirical vancomycin. The median postnatal age at first positive culture was 14 days (interquartile range: 9, 21). Unadjusted 30-day mortality was similar for infants treated with empirical vancomycin and infants treated with delayed vancomycin therapy [166/2848 (6%) vs. 69/1516 (4%); P = 0.08]. There was no significant difference in 30-day mortality on multivariable analysis [odds ratio: 1.14 (0.84, 1.56)]. The median duration of bacteremia was 1 day longer for infants with delayed vancomycin therapy [4 days (interquartile range: 2, 6) vs. 3 days (2, 5); P < 0.0001]. CONCLUSIONS: The median duration of bacteremia was 1 day longer in infants with CoNS BSI who received delayed vancomycin therapy. Despite this finding, empirical vancomycin therapy for CoNS BSI was not associated with improved mortality.
BACKGROUND: Coagulase-negative Staphylococcus (CoNS) is the most common cause of bloodstream infections (BSI) in hospitalized infants. CoNS BSI is most reliably treated with vancomycin; however, concerns about side effects and promoting resistance often delay empirical vancomycin therapy until culture results become available. METHODS: All infants with CoNS BSI discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group from 1997 to 2012 were identified. Empirical vancomycin therapy was defined as vancomycin exposure on the day of the first positive blood culture. Delayed vancomycin therapy was defined as vancomycin exposure 1-3 days after the first positive blood culture. We used multivariable logistic regression with random effects for site to evaluate the association between the use of empirical vancomycin therapy versus delayed vancomycin therapy and 30-day mortality, controlling for gestational age, small-for-gestational age status, postnatal age on the day of the first positive culture, oxygen requirement, ventilator support and inotropic support on the day the first positive culture was obtained. RESULTS: A total of 4364 infants with CoNS BSI were identified; 2848 (65%) were treated with empirical vancomycin. The median postnatal age at first positive culture was 14 days (interquartile range: 9, 21). Unadjusted 30-day mortality was similar for infants treated with empirical vancomycin and infants treated with delayed vancomycin therapy [166/2848 (6%) vs. 69/1516 (4%); P = 0.08]. There was no significant difference in 30-day mortality on multivariable analysis [odds ratio: 1.14 (0.84, 1.56)]. The median duration of bacteremia was 1 day longer for infants with delayed vancomycin therapy [4 days (interquartile range: 2, 6) vs. 3 days (2, 5); P < 0.0001]. CONCLUSIONS: The median duration of bacteremia was 1 day longer in infants with CoNS BSI who received delayed vancomycin therapy. Despite this finding, empirical vancomycin therapy for CoNS BSI was not associated with improved mortality.
Authors: N Ofek-Shlomai; S Benenson; Z Ergaz; O Peleg; R Braunstein; B Bar-Oz Journal: Eur J Clin Microbiol Infect Dis Date: 2011-08-04 Impact factor: 3.267
Authors: Naomi Jean-Baptiste; Daniel K Benjamin; Michael Cohen-Wolkowiez; Vance G Fowler; Matthew Laughon; Reese H Clark; P Brian Smith Journal: Infect Control Hosp Epidemiol Date: 2011-07 Impact factor: 3.254
Authors: Jane W A Vella-Brincat; Evan J Begg; Barbara J Robertshawe; Adrienne M Lynn; Tracey L Borrie; Brian A Darlow Journal: Neonatology Date: 2011-04-01 Impact factor: 4.035
Authors: S B Ascher; P B Smith; R H Clark; M Cohen-Wolkowiez; J S Li; K Watt; E Jacqz-Aigrain; F Kaguelidou; P Manzoni; D K Benjamin Journal: Early Hum Dev Date: 2012-05 Impact factor: 2.079
Authors: Chia-Hua Chiu; Ian C Michelow; Jonathan Cronin; Steven A Ringer; Timothy G Ferris; Karen M Puopolo Journal: Pediatr Infect Dis J Date: 2011-04 Impact factor: 2.129
Authors: Barbara J Stoll; Nellie I Hansen; Ira Adams-Chapman; Avroy A Fanaroff; Susan R Hintz; Betty Vohr; Rosemary D Higgins Journal: JAMA Date: 2004-11-17 Impact factor: 56.272
Authors: Sarah A Coggins; Jörn-Hendrik Weitkamp; Lisa Grunwald; Ann R Stark; Jeff Reese; William Walsh; James L Wynn Journal: Arch Dis Child Fetal Neonatal Ed Date: 2015-10-30 Impact factor: 5.747
Authors: Sarah B Doernberg; Thomas P Lodise; Joshua T Thaden; Jose M Munita; Sara E Cosgrove; Cesar A Arias; Helen W Boucher; G Ralph Corey; Franklin D Lowy; Barbara Murray; Loren G Miller; Thomas L Holland Journal: Clin Infect Dis Date: 2017-03-15 Impact factor: 9.079
Authors: Jadon S Wagstaff; Robert J Durrant; Michael G Newman; Rachael Eason; Robert M Ward; Catherine M T Sherwin; Elena Y Enioutina Journal: Front Pharmacol Date: 2019-10-15 Impact factor: 5.810