Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative <i>Staphylococcus</i>

Romanelli, Roberta Maia de Castro; Anchieta, Lêni Márcia; Silva, Ana Carolina Bueno e; Jesus, Lenize Adriana de; Rosado, Viviane; Clemente, Wanessa Trindade

doi:10.1016/j.jped.2016.01.008

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 92 (5) • Sep-Oct 2016 • https://doi.org/10.1016/j.jped.2016.01.008 copy

Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus^☆ ☆ Please cite this article as: Romanelli RM, Anchieta LM, Silva AC, de Jesus LA, Rosado V, Clemente WT. Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus. J Pediatr (Rio J). 2016;92:472-8. ^☆☆ ☆☆ Study conducted at Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aim of this study was to compare two different empiric treatments for late-onset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase-negative Staphylococcus.

Methods:

A cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at-risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program.

Results:

There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram-negative bacterial or fungal infections. An increase in coagulase-negative Staphylococcus infections was observed (p = 0.022). However, there was no measured increase in related morbidity and mortality. There was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p < 0.001) and an increase of one day in the median number of days of treatment with vancomycin (p = 0.046).

Conclusions:

Modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in S. aureus infections, as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. As a result, oxacillin can be considered as an effective treatment for late-onset sepsis, making it possible to avoid broad-spectrum antibiotics.

Keywords
Sepsis; Neonate; Staphylococcus; Oxacillin; Vancomycin

Weight (g)	Total	Period 1	Period 2	p	OR	95% CI
	(2011-2014)	(2011-2012)	(2013-2014)
<750	27.01	26.67	27.3	0.945	0.98	0.50-1.90
751-1000	24.02	26.37	22.25	0.424	1.18	0.78-1.80
1001-1500	19.57	18.88	20.15	0.757	0.94	0.62-1.41
1501-2500	25.59	29.76	21.62	0.025	1.38	1.04-1.82
>2500	19.18	20.56	18.01	0.389	1.14	0.84-1.54
Total	22.20	24.21	20.50	0.044	1.18	1.00-1.39

Microorganism	Total	Period 1	Period 2	p	OR	95% CI
	2011-2014	2011-2012	2013-2014
	n (%)	n (%)	n (%)
Coagulase negative Staphylococcus	117 (9.52)	40 (7.37)	77 (11.22)	0.028	0.63	0.41-0.95
Staphylococcus aureus	42 (3.42)	27 (4.97)	15 (2.19)	0.012	2.34	1.18-4.67
Gram negative bacillus	91 (7.40)	47 (8.66)	44 (6.41)	0.167	1.38	0.88-2.17
Fungi	14 (1.14)	6 (1.10)	8 (1.17)	0.865	0.95	0.27-3.13

Topography	Microorganism	Period 1	Period 2	p	OR	95% CI
		n (%)	n (%)
Conjuntivitis	CoNS	5 (38.5)	2 (22.2)	0.648	2.19	0.23-20.0
	S. aureus	3 (23.1)	2 (22.2)	1	1.05	0.10-12.44
Endocarditis	CoNS	-	-	-	-	-
	S. aureus	3 (100)	0	-	-	-
Necrotizing enterocolitis	CoNS	-	1 (6.7)	-	-	-
	S. aureus	-	0	-	-	-
Intra-abdominal infection	CoNS	-	1 (50)	-	-	-
	S. aureus	-	0	-	-	-
Vascular infection	CoNS	-	3 (100)	-	-	-
	S. aureus	-	0	-	-	-
Skin or soft tissue infection	CoNS	0	2 (3.2)	-	-	-
	S. aureus	1 (2.0)	1 (1.6)	1	1.22	0.0-20.0
Bronchial or tracheal infection	CoNS	0	-	-	-	-
	S. aureus	1 (50.0)	-	-	-	-
Pneumonia	CoNS	0	-	-	-	-
	S. aureus	1 (8.3)	-	-	-	-
Urinary tract infection	CoNS	1 (7.1)	2 (13.3)	1	0.5	0.02-8.61
	S. aureus	0	0	-	-	-
Central nervous system infection	CoNS	0	2 (28.6)	-	-	-
	S. aureus	3 (15.8)	0	-	-	-
Bloodstream infection (sepsis)	CoNS	34 (21.38)	64 (38.1)	0.001	0.44	0.26-0.74
	S. aureus	15 (9.4%)	12 (7.1)	0.58	1.34	0.58-3.20

Mortality/lethality	Total	Period 1	Period 2	p	OR	95% CI
	2011-2014	2011-2012	2013-2014
	n (%)	n (%)	n (%)
General mortality
Coagulase negative Staphylococcus/patient at risk	3 (0.24)	1 (0.18)	2 (0.29)	0.63	0.63	0.06-6.95
Staphylococcus aureus/patient at risk	6 (0.49)	5 (0.92)	1 (0.15)	0.08	6.32	0.74-53.91

Lethality associated to coagulase negative Staphylococcus
Coagulase negative Staphylococcus /total of infections	3 (0.82)	1 (0.56)	2 (1.07)	1	0.52	0.02-7.32
S. coagulase negative/total of infections by agent	3 (2.56)	1 (2.5)	2 (2.6)	1	0.96	0-14.16

Lethality associated to Staphylococcus aureus
S. aureus /total of infections	6 (1.63)	5 (2.78)	1 (0.53)	0.116	5.31	0.6-20.0
S. aureus /total of infections by agent	6 (14.29)	5 (18.52)	1 (6.67)	0.395	3.18	0.3-30.0

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:rmcromanelli@gmail.com (T. Konstantyner).