Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus

Abstract

Modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in S. aureus infections, as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. As a result, oxacillin can be considered as an effective treatment for late-onset sepsis, making it possible to avoid broad-spectrum antibiotics.

Prevalence of central venous catheter salvage in newborn with staphylococcal bloodstream infection

“…Many NB received antibiotic therapy prior to the diagnosis of CRBSI. Authors emphasize that a low number of infections is directly related to the restricted use of antimicrobial agents (33) . The empirical use of these drugs changes the newborn's microbiota, thereby increasing colonization by pathogenic bacteria and predisposing to bloodstream infection in premature infants (20) .…”

“…Few deaths were related to CRBSI. Mortality associated with CNS has not exceeded 1%, and fulminant deaths occurred in patients with other comorbidities when the blood culture result was positive for more than one microorganism (33) .…”

“…Although there is resistance to oxacillin in many neonatal units, the administration of this drug associated with amikacin was effective in saving the CVC in 13 cases of CRBSI. Brazilian studies prove the efficacy of anti-staphylococcal β lactam to treat CRBSIs (33,38) .…”

“…The frequency of death in the sample studied was low, as were the cases associated with CRBSI, thus the conclusion that the attempt to salvage infected CVCs did not increase the risk for mortality among NB. Infections by CNS have an insidious evolution and low morbidity and mortality (33) .…”

Sepse tardia em Unidade de Tratamento Intensivo Neonatal

“…Também, deve ser levado em consideração o fato de os SCN serem microrganismos minimamente invasivos que estão presentes nos microbiomas de neonatos após o nascimento, porém alguns RNs, através de mecanismos de defesa inadequados, apresentam maior susceptibilidade a infecção por esses microrganismos. 22 Esse estudo evidenciou maior prevalência de sepse neonatal em RNs prematuros e de baixo peso que necessitaram de maiores cuidados e foram submetidos a procedimentos invasivos durante o período de permanência na UTIN. Houve associação estatística significativa entre a necessidade de ventilação mecânica, realização de cirurgia e permanência no hospital por mais de um mês com hemocultura positiva.…”