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No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants.

Publication ,  Journal Article
Ericson, JE; Thaden, J; Cross, HR; Clark, RH; Fowler, VG; Benjamin, DK; Cohen-Wolkowiez, M; Hornik, CP; Smith, PB ...
Published in: Pediatr Infect Dis J
April 2015

BACKGROUND: Coagulase-negative Staphylococcus (CoNS) is the most common cause of bloodstream infections (BSI) in hospitalized infants. CoNS BSI is most reliably treated with vancomycin; however, concerns about side effects and promoting resistance often delay empirical vancomycin therapy until culture results become available. METHODS: All infants with CoNS BSI discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group from 1997 to 2012 were identified. Empirical vancomycin therapy was defined as vancomycin exposure on the day of the first positive blood culture. Delayed vancomycin therapy was defined as vancomycin exposure 1-3 days after the first positive blood culture. We used multivariable logistic regression with random effects for site to evaluate the association between the use of empirical vancomycin therapy versus delayed vancomycin therapy and 30-day mortality, controlling for gestational age, small-for-gestational age status, postnatal age on the day of the first positive culture, oxygen requirement, ventilator support and inotropic support on the day the first positive culture was obtained. RESULTS: A total of 4364 infants with CoNS BSI were identified; 2848 (65%) were treated with empirical vancomycin. The median postnatal age at first positive culture was 14 days (interquartile range: 9, 21). Unadjusted 30-day mortality was similar for infants treated with empirical vancomycin and infants treated with delayed vancomycin therapy [166/2848 (6%) vs. 69/1516 (4%); P = 0.08]. There was no significant difference in 30-day mortality on multivariable analysis [odds ratio: 1.14 (0.84, 1.56)]. The median duration of bacteremia was 1 day longer for infants with delayed vancomycin therapy [4 days (interquartile range: 2, 6) vs. 3 days (2, 5); P < 0.0001]. CONCLUSIONS: The median duration of bacteremia was 1 day longer in infants with CoNS BSI who received delayed vancomycin therapy. Despite this finding, empirical vancomycin therapy for CoNS BSI was not associated with improved mortality.

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Published In

Pediatr Infect Dis J

DOI

EISSN

1532-0987

Publication Date

April 2015

Volume

34

Issue

4

Start / End Page

371 / 375

Location

United States

Related Subject Headings

  • Vancomycin
  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Staphylococcus
  • Staphylococcal Infections
  • Secondary Prevention
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
 

Citation

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Ericson, J. E., Thaden, J., Cross, H. R., Clark, R. H., Fowler, V. G., Benjamin, D. K., … Antibacterial Resistance Leadership Group, . (2015). No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J, 34(4), 371–375. https://doi.org/10.1097/INF.0000000000000573
Ericson, Jessica E., Joshua Thaden, Heather R. Cross, Reese H. Clark, Vance G. Fowler, Daniel K. Benjamin, Michael Cohen-Wolkowiez, Christoph P. Hornik, P Brian Smith, and P Brian Antibacterial Resistance Leadership Group. “No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants.Pediatr Infect Dis J 34, no. 4 (April 2015): 371–75. https://doi.org/10.1097/INF.0000000000000573.
Ericson JE, Thaden J, Cross HR, Clark RH, Fowler VG, Benjamin DK, et al. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J. 2015 Apr;34(4):371–5.
Ericson, Jessica E., et al. “No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants.Pediatr Infect Dis J, vol. 34, no. 4, Apr. 2015, pp. 371–75. Pubmed, doi:10.1097/INF.0000000000000573.
Ericson JE, Thaden J, Cross HR, Clark RH, Fowler VG, Benjamin DK, Cohen-Wolkowiez M, Hornik CP, Smith PB, Antibacterial Resistance Leadership Group. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J. 2015 Apr;34(4):371–375.

Published In

Pediatr Infect Dis J

DOI

EISSN

1532-0987

Publication Date

April 2015

Volume

34

Issue

4

Start / End Page

371 / 375

Location

United States

Related Subject Headings

  • Vancomycin
  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Staphylococcus
  • Staphylococcal Infections
  • Secondary Prevention
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal