Combination of vancomycin and rifampicin for the treatment of persistent coagulase-negative staphylococcal bacteremia in
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Combination of vancomycin and rifampicin for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates Luciana Rodriguez-Guerineau & María Dolors Salvia-Roigés & Marisol León-Lozano & José Manuel Rodríguez-Miguélez & Josep Figueras-Aloy
Received: 20 August 2012 / Revised: 16 December 2012 / Accepted: 24 December 2012 / Published online: 18 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Coagulase-negative staphylococci are the most common cause of late-onset sepsis in premature neonates. The optimal approach in persistent coagulase-negative staphylococcal bacteremia, despite adequate treatment with glycopeptides, is not well established. A retrospective study was conducted on preterm neonates with persistent coagulasenegative staphylococcal bacteremia treated with the combination of vancomycin–rifampicin. Ten cases were included, with a median gestational age of 26 weeks (range 24 weeks+3 days– 31 weeks+4 days, interquartile range 25 weeks+3 days– 29 weeks+3 days) and a median birth weight of 715 g (range 555–2,030). The median age at the onset of infection was 9 days (range 5–37). The most frequent clinical presentation was apnea or increased ventilatory support. Bacteremia persisted for a median of 9 (range 6–19)days until rifampicin initiation. Bacteremia was resolved in all cases on vancomycin–rifampicin with no serious side effects. Conclusion: Our study provides data supporting the safety and efficacy of vancomycin–rifampicin combination for the treatment of persistent coagulasenegative staphylococcal bacteremia in preterm neonates. Keywords Coagulase-negative staphylococci . Bacteremia . Rifampicin . Neonate
L. Rodriguez-Guerineau (*) : M. D. Salvia-Roigés : M. León-Lozano : J. M. Rodríguez-Miguélez : J. Figueras-Aloy Department of Neonatology, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic- Hospital Sant Joan de Déu, University of Barcelona, Villarroel No. 170, 08036 Barcelona, Spain e-mail: [email protected]
Introduction Coagulase-negative staphylococci (CoNS) have emerged as the most prevalent neonatal pathogen, responsible for more than 25 % of late-onset sepsis (>72 h of age) in neonates born weighing less than 1,500 g at birth (VLBW) [3]. The risk of CoNS sepsis increases at lower weight and gestational age. Vancomycin is the drug of choice for these infections. However, in some cases, the bacteremia persists despite antibiotic sensitivity and levels within the therapeutic range. In this article, we describe the cases with persistent CoNS bacteremia treated with the vancomycin–rifampicin combination.
Methods We evaluated retrospectively collected data from all preterm neonates admitted to the Neonatal Intensive Care Unit between April 2006 and December 2011, who received vancomycin–rifampicin for the treatment of persistent CoNS bacteremia. Risk factors, clinical presentation, laboratory findings, previous treatment, and outcome were recorded in a case report form. Laboratory abnormalities were d
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