Selective use of vancomycin to prevent coagulase-negative staphylococcal nosocomial bacteremia in high risk very low birth weight infants.

Abstract

OBJECTIVE:

To determine whether vancomycin added to parental nutrition (PN) fluids could prevent nosocomial infections in very low birth weight newborns and which infants would benefit most from prophylaxis.

DESIGN:

Double blind, randomized controlled study.

SETTING AND STUDY POPULATION:

Very low birth weight infants receiving PN in a tertiary neonatal intensive care unit.

METHODS:

Thirty-eight infants with and without central vascular catheters were randomized to receive no medication or 25 microg/ml vancomycin added to PN for the duration of the infant's PN requirements.

RESULTS:

The addition of 25 microg/ml vancomycin to PN prevented bacteremia in very low birth weight infants receiving PN. There was a significant reduction in the number of coagulase-negative staphylococcal (CONS) bacteremias (defined as isolation of the same organism from two positive blood cultures) during PN (5 vs. 0; P = 0.037) as well as the total number of bacteremias and fungemias (9 vs. 1; P = 0.036). The total number of hospital days (108 +/- 13 vs. 76 +/- 6; P = 0.039) were reduced in infants receiving vancomycin. Infants with birth weights of < 1000 g who received corticosteroids for treatment of chronic lung disease benefitted most from treatment. No vancomycin-resistant strains of CONS or enterococci were detected during the study period.

CONCLUSIONS:

Prophylactic treatment with vancomycin effectively prevented CONS bacteremia under the conditions of the study. Its use was most effective in infants with birth weights of <1000 g.

• Authors: R J Baier, J A Bocchini Jr, E G Brown
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 17 Issue 3 Pg. 179-83 (Mar 1998) ISSN: 0891-3668 [Print] United States
• PMID: 9535242 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Bacterial Agents
• Vancomycin

Topics

• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Bacteremia (prevention & control)
• Cross Infection (prevention & control)
• Double-Blind Method
• Humans
• Infant, Newborn
• Infant, Very Low Birth Weight
• Intensive Care Units, Neonatal
• Parenteral Nutrition
• Regression Analysis
• Risk
• Staphylococcal Infections (prevention & control)
• Statistics, Nonparametric
• Vancomycin (administration & dosage, therapeutic use)