title: Duration of vancomycin treatment for coagulase-negative Staphylococcus sepsis in very low birth weight infants.
abstract: OBJECTIVE
  Vancomycin 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  In VLBW infants with uncomplicated CoNS sepsis, treatment with vancomycin for 5 days after the last positive blood culture appears to be associated with a satisfactory outcome and no adverse effects. A well-controlled prospective multicentre study is needed to confirm these findings.
authors.affiliation: Department of Neonatology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel. nehama.linder@gmail.com
authors.forename: Nehama
authors.initials: N
authors.lastname: Linder
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubin
authors.forename: Adriana
authors.initials: A
authors.lastname: Hernandez
authors.forename: Limor
authors.initials: L
authors.lastname: Amit
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D003030:Coagulase / Q000378:metabolism; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013210:Staphylococcus / Q000201:enzymology / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D003030:Coagulase; D014640:Vancomycin