title: Use of rifampin in persistent coagulase negative staphylococcal bacteremia in neonates.
abstract: BACKGROUND
  Coagulase negative staphylococci (CoNS) are the most common cause of neonatal sepsis in the Neonatal Intensive Care Unit (NICU). A minority of neonates does not respond to vancomycin therapy and develops persistent bacteremia, which may be treated with rifampin. We evaluated the use of rifampin in persistent CoNS bacteremia.
  
  
  METHODS
  Retrospective study of 137 neonates with CoNS bacteremia during admission to a tertiary NICU between July 2006 and July 2009. Main outcome measures were total duration of bacteremia and the adequacy of vancomycin and rifampin therapy.
  
  
  RESULTS
  137/1696 (8.0%) neonates developed a CoNS bacteremia. Eighteen were treated with rifampin because of persistent bacteremia (3 positive blood cultures at least 48 hours apart with clinical symptoms) or (a serious suspicion of) an intravascular thrombus. Duration of bacteremia prior to rifampin therapy (8.0 ± 3.6 days) was positively correlated (p < 0.001) to the total duration of bacteremia (10.3 ± 3.7 days). After starting rifampin therapy C-reactive protein (CRP) levels of all neonates declined and blood cultures became sterile after 2.3 ± 1.6 days. Vancomycin levels were not consistently measured in all neonates, resulting in late detection of subtherapeutic trough levels.
  
  
  CONCLUSIONS
  Rifampin may be effective in the treatment of persistent CoNS infections in neonates. Outcome may be improved by adequate monitoring of vancomycin trough levels.
authors.affiliation: Department of Pediatrics, Leiden University Medical Center, The Netherlands.
authors.forename: N Margreth
authors.initials: NM
authors.lastname: van der Lugt
authors.forename: Sylke J
authors.initials: SJ
authors.lastname: Steggerda
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism; D003030:Coagulase / Q000032:analysis*; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D013210:Staphylococcus / Q000201:enzymology* / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D003030:Coagulase; D004791:Enzyme Inhibitors; D002097:C-Reactive Protein; D012293:Rifampin