Prevention of gram-positive sepsis in neonates weighing less than 1500 grams.
A prospective, randomized study to evaluate the effectiveness of a continuous low-dose vancomycin infusion to prevent nosocomial gram-positive bacteremia was initiated within the first 2 weeks of life in neonates weighing < 1500 gm. Seventy-one infants received constant infusion of vancomycin (25 micrograms/ml) mixed with their total parenteral nutrition solution; 70 infants served as control subjects. The groups were clinically similar in birth weight, estimated gestational age, and severity of illness. Administration of vancomycin was begun at a mean age of 5.4 +/- 2.9 days. Infants had mean serum vancomycin concentrations of 2.4 micrograms/ml, and received vancomycin for a mean of 11 +/- 7 days. No vancomycin-resistant organisms were detected in surveillance cultures during the 2-year study period. Twenty-four of seventy control infants, in comparison with 1 of 71 infants receiving vancomycin, had gram-positive bacteremia (p < 0.001). The addition of a low dose of vancomycin to alimentation fluids virtually eliminated the incidence of gram-positive bacteremia in an at-risk population of very low birth weight infants. However, the widespread use of vancomycin in total parenteral nutrition solution is not recommended until better data on the emergence of vancomycin-resistant organisms are available.
Kacica
M A
MA
Department of Pediatrics, Albany Medical College, NY 12208.
Horgan
M J
MJ
Ochoa
L
L
Sandler
R
R
Lepow
M L
ML
Venezia
R A
RA
D016470:Bacteremia / Q000517:prevention & control*; D003030:Coagulase; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007230:Infant, Low Birth Weight / Q000382:microbiology; D007231:Infant, Newborn; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
D003030:Coagulase; D014640:Vancomycin