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Treatment of suspected neonatal sepsis with a central line in-situ – do we always need vancomycin?
  1. K Richards,
  2. S Banerjee
  1. ABM University Health Board, Swansea, UK

Abstract

Background Coagulase negative staphylococcus (CONS) is the commonest cause of central line related neonatal sepsis. There is a perception that the majority of CONS strains are resistant to usual anti-staphylococcal regime and require vancomycin based antibiotic combinations if a central line is in-situ. Presumptive treatment for infection is more prevalent than true sepsis and may lead to overuse of vancomycin with consequent emergence of cross resistance for example, vancomycin resistant enterococci.

Aims To determine the antibiotic sensitivity of CONS isolates from a neonatal intensive care environment to guide rational antibiotic policy.

Methods CONS isolates on blood cultures and their antibiotic sensitivities were analysed from the microbiology database over a 2 year period.

Results A total of 110 CONS positive blood cultures were identified, of which 68 (62%) were sensitive to at least one of flucloxacillin and gentamicin. More isolates were sensitive to gentamicin than flucloxacillin (45 vs 28) with only five sensitive to both antibiotics in-vitro. All CONS strains were sensitive to vancomycin.

Discussion CONS infection usually starts as a low-grade illness. Flucloxacillin and gentamicin combination provides adequate coverage in many cases and avoids unnecessary vancomycin use in the presumptive phase of the clinical decision. Judicious removal of central lines and additional synergistic effect in-vivo should improve effectiveness of this combination.

Conclusion In carefully selected low-risk babies, presumptive treatment with flucloxacillin and gentamicin along with judicious removal of central line is a viable option. Vancomycin should be reserved for high-risk babies with precious central lines or guided by confirmed antibiotic sensitivity results.

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