Duration of vancomycin treatment for coagulase‐negative Staphylococcus sepsis in very low birth weight infants

Abstract

AIMVancomycin is widely used to treat late onset coagulase-negative Staphylococcus (CoNS) sepsis in very low birth weight (VLBW) infants. Although vancomycin is associated with a risk of toxicity and bacterial resistance, the appropriate duration of use has not been established. This study sought to investigate the association between the duration of vancomycin therapy and clinical outcome in VLBW infants with CoNS sepsis. METHODSThe files of all VLBW infants treated for CoNS sepsis at a tertiary paediatric medical centre from 1995-2003 were reviewed for clinical data, laboratory variables and outcome. Only patients with two positive diagnostic blood cultures were included. The findings were analyzed by duration of vancomycin treatment after the last positive blood culture. RESULTSThe study cohort included 126 infants, 48 treated for 5 days, 32 for 6-7 days, 31 for 8-10 days and 15 for >10 days. There were no differences among the groups in perinatal characteristics, central catheter dwell time, laboratory data including haematologic, renal and liver function tests, or rate of complications of prematurity. Five infants were diagnosed with infective endocarditis or aortic thrombi and were treated for >10 days. CoNS sepsis recurred in two infants (1.6%). No toxicity of vancomycin treatment was observed.

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

“…Observational studies suggest that longer exposure to antibiotics is associated with risk of potential adverse events including necrotizing enterocolitis in very low birthweight infants [144], candidemia in hospitalized children [145,146], development of antimicrobial resistance [147] and C. difficile (formerly Clostridium) infection [148]. Several meta-analyses, RCTs, and observational studies have compared long-versus short-duration antibiotic therapy for serious infections [140,144,[149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164][165][166][167]. Most studies suggest that shorter courses were associated with similar clinical outcomes compared with longer durations; these include neonatal bacteremia [158,163], pyelonephritis [168], uncomplicated bacterial meningitis [154, 155, 159-161, 164, 165], and pneumonia [169,170].…”

Seven versus 10 days antibiotic therapy for culture‐proven neonatal sepsis: A randomised controlled trial

“…Recently, a few studies have shown that a shorter duration of antibiotic therapy may be as effective as the conventionally accepted longer duration of antibiotic therapy for treating septicaemia in children . However, very few studies comparing short course versus traditionally accepted longer duration of antibiotic therapy for treating neonatal sepsis are available . We conducted this randomised controlled trial with the objective of comparing the efficacy of 7 versus 10 days duration of intravenous antibiotics for treating blood culture‐proven neonatal sepsis.…”

“…[9][10][11][12][13] However, very few studies comparing short course versus traditionally accepted longer duration of antibiotic therapy for treating neonatal sepsis are available. [14][15][16][17][18] We conducted this randomised controlled trial with the objective of comparing the efficacy of 7 versus 10 days duration of intravenous antibiotics for treating blood culture-proven neonatal sepsis.…”

Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates

“…Stéphanie Leroux https://orcid.org/0000-0003-2727-5269 Stéphanie Leroux 1,2 Johannes N. van den Anker 1,3 Anne Smits 4,5 Marc Pfister 1,6 Karel Allegaert 5…”

“…Optimal dosing of vancomycin in neonates remains a matter of debate despite the frequent use of vancomycin in neonatal intensive care units (NICUs). 1,2 The optimal use of vancomycin requires knowledge of its pharmacokinetics (PK) and pharmacodynamics (PD) properties in neonates. The ratio of 24-hour area under the concentration versus time curve to minimal inhibitory concentration (AUC 24 /MIC) was shown to be the best PK/PD surrogate marker of vancomycin efficacy.…”