1394 Clinical Outcome of Neonatal Conssepsis with a Vancomycin-Sparing Regimen: Favourable Results with Cefazolin as First Choice Agent

Abstract

Background and aims: The typical empiric antimicrobial treatment protocol for neonatal coagulase-negative staphylococci (CONS) sepsis includes vancomycin. However, the protocol in our NICU prescribes cefazolin to cover CONS. The susceptibility of CONS blood isolates to cefazolin and clinical outcome of infants with CONS sepsis was studied during 2000-2006.

Methods: Clinical characteristics, symptoms of sepsis and antibiotic use were studied retrospectively. Susceptibility of CONS blood isolates to cefazolin was determined by E-test.

Results: 163/185 infants with proven CONS sepsis were treated with cefazolin. Median MIC value of cefazolin was 0.75-2 (range 0.01-256) µg/ml and 77-96% of all isolates was susceptible to cefazolin (MIC ≤8 µg/ml) during 2000-2006. In 121/140 (86%) infants with cefazolin-susceptible and 21/23 cases (91%) with cefazolin-resistant CONS isolate cefazolin was clinically efficacious. 12/17 second blood cultures in 19 non-responders yielded CONS with unchanged MIC. In 78% of good responders and 22% of non-responders a central venous catheter was removed at onset of sepsis. Nonresponders were switched to vancomycin.

Conclusions: Majority of CONS isolates remained susceptible to cefazolin over a period of 7 years. Cefazolin is clinically efficacious in >85% of cases and can be recommended as first choice agent for therapy of CONS sepsis. Removal of a central venous catheter may be the most important therapeutic measure.

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