title: Positive blood cultures for coagulase-negative staphylococci in neonates: does highly selective vancomycin usage affect outcome?
abstract: The implication of highly-selective vancomycin usage on the outcome for infants with positive blood cultures for coagulase-negative staphylococci (CONS) was assessed retrospectively. The analysis was performed on partly prospective collected data from infants under 3 months of age with a least one CONS-positive blood culture in the neonatal intensive care unit at the Soroka University Medical Center between 1990 and 1996. During the study period, 239 episodes of CONS-positive blood cultures were identified from among 64,226 live births (3.7 per 1,000). Vancomycin was administered in 22 (9%) episodes, in all cases only after identification of the bacteria. The remaining 217 episodes were managed either without antibiotics or with continuation or initiation of empiric antibiotic therapy (usually ceftazidime +/- ampicillin) for suspected sepsis. Severity of the initial illness, subsequent morbidity and mortality were low regardless of the treatment administered. Only a single case of a blood-borne vancomycin resistant gram-positive organism was observed during the study period. The approach to CONS-positive blood cultures in neonates used here was associated with low morbidity and mortality. These findings support a policy of highly selective vancomycin usage in an era of emerging vancomycin resistance.
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Matrai-Kovalskis
authors.forename: D
authors.initials: D
authors.lastname: Greenberg
authors.forename: E S
authors.initials: ES
authors.lastname: Shinwell
authors.forename: D
authors.initials: D
authors.lastname: Fraser
authors.forename: R
authors.initials: R
authors.lastname: Dagan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003030:Coagulase / Q000096:biosynthesis; D004352:Drug Resistance, Microbial; D006801:Humans; D007231:Infant, Newborn; D009017:Morbidity; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D013210:Staphylococcus / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D003030:Coagulase; D014640:Vancomycin