Prevention of gram-positive sepsis in neonates weighing less than 1500 grams

• Published in: The Journal of pediatrics Vol. 125; no. 2; pp. 253 - 258
• Main Authors: Kacica, Marilyn A., Horgan, Michael J., Ochoa, Luis, Sandler, Roberta, Lepow, Martha L., Venezia, Richard A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-1994; Elsevier; Mosby-Year Book, Inc
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - prevention & control; Biological and medical sciences; Coagulase; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Gram-Positive Bacteria - isolation & purification; Humans; Infant, Low Birth Weight - microbiology; Infant, Newborn; Intensive care medicine; Medical sciences; Parenteral Nutrition, Total; Prospective Studies; Staphylococcal Infections - prevention & control; Vancomycin - administration & dosage; Vancomycin - therapeutic use; NICU; MIC; CONS; Human; Premature; Nosocomial infection; Pregnancy disorders; Continuous; Septicemia; Low dose; Bacteremia; Parenteral administration; Feeding; Infection; Very low birthweight; Prevention; Antibiotic; Newborn diseases; Newborn; Gram positive bacteria; Bacteriosis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(94)70207-1

A prospective, randomized study to evaluate the effectiveness of a continuous low-dose vancomycin infusion to prevent nosocomial gram-positive bacteremia was initiated within the first 2 weeks of life in neonates weighing <1500 gm. Seventy-one infants received constant infusion of vancomycin (25 μg/ml) mixed with their total parenteral nutrition solution; 70 infants served as control subjects. The groups were clinically similar in birth weight, estimated gestational age, and severity of illness. Administration of vancomycin was begun at a mean age of 5.4 ± 2.9 days. Infants had mean serum vancomycin concentrations of 2.4 μg/ ml, and received vancomycin for a mean of 11 ± 7 days. No vancomycin-resistant organisms were detected in surveillance cultures during the 2-year study period. Twenty-four of seventy control infants, in comparison with 1 of 71 infants receiving vancomycin, had gram-positive bacteremia (p<0.001). The addition of a low dose of vancomycin to alimentation fluids virtually eliminated the incidence of gram-positive bacteremia in an at-risk population of very low birth weight infants. However, the widespread use of vancomycin in total parenteral nutrition solution is not recommended until better data on the emergence of vancomycin-resistant organisms are available. (J PEDIATR 1994;125:253-8)