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Use of rifampin in persistent coagulase negative staphylococcal bacteremia in neonates.

AbstractBACKGROUND:
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.
CONCLUSION:
Rifampin may be effective in the treatment of persistent CoNS infections in neonates. Outcome may be improved by adequate monitoring of vancomycin trough levels.
AuthorsN Margreth van der Lugt, Sylke J Steggerda, Frans J Walther
JournalBMC pediatrics (BMC Pediatr) Vol. 10 Pg. 84 (Nov 19 2010) ISSN: 1471-2431 [Electronic] England
PMID21092087 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Coagulase
  • Enzyme Inhibitors
  • C-Reactive Protein
  • Rifampin
Topics
  • Bacteremia (blood, drug therapy, microbiology)
  • C-Reactive Protein (metabolism)
  • Coagulase (analysis)
  • Dose-Response Relationship, Drug
  • Enzyme Inhibitors (administration & dosage, therapeutic use)
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Retrospective Studies
  • Rifampin (administration & dosage, therapeutic use)
  • Staphylococcal Infections (blood, drug therapy, microbiology)
  • Staphylococcus (enzymology, isolation & purification)
  • Treatment Outcome

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