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 coagulase-negative 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 coagulase-negative staphylococcal bacteremia in preterm neonates.
References
Avila-Figueroa C, Goldmann DA, Richardson DK, Gray JE, Ferrari A, Freeman J (1998) Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns. Pediatr Infect Dis J17:10–17
Cheung GY, Otto M (2010) Understanding the significance of Staphylococcus epidermidis bacteremia in babies and children. Curr Opin Infect Dis 23:208–216
Hornik CP, Fort P, Clark RH et al (2012) Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 88:S69–S74
Karlowicz MG, Furigay PJ, Croitoru DP, Buescher ES (2002) Central venous catheter removal versus in situ treatment in neonates with coagulase-negative staphylococcal bacteremia. Pediatr Infect Dis J21:22–27
Khashu M, Osiovich H, Henry D, Al Khotani A, Solimano A, Speert DP (2006) Persistent bacteremia and severe thrombocytopenia caused by coagulase-negative Staphylococcus in a neonatal intensive care unit. Pediatrics 117:340–348
Klingenberg C, Rønnestad A, Anderson AS et al (2007) Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit: virulence factors and invasiveness. Clin Microbiol Infect 13:1100–1111
Linder N, Hernandez A, Amit L, Klinger G, Ashkenazi S, Levy I (2011) Persistent coagulase-negative staphylococci bacteremia in very-low-birth-weight infants. Eur J Pediatr 170:989–995
Maayan-Metzger A, Linder N, Marom D, Vishne T, Ashkenazi S, Sirota L (2000) Clinical and laboratory impact of coagulase-negative staphylococci bacteremia in preterm infants. Acta Paediatr 89:690–693
Perlman SE, Saiman L, Larson EL (2007) Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 35:177–182
Rose WE, Poppens PT (2009) Impact of biofilm on the in vitro activity of vancomycin alone and in combination with tigecycline and rifampicin against Staphylococcus aureus. J Antimicrob Chemother 63:485–488
Scheifele DW, Bjornson GL, Dyer RA, Dimmick JE (1987) Delta-like toxin produced by coagulase-negative staphylococci is associated with neonatal necrotizing enterocolitis. Infect Immun 55:2268–2273
Shama A, Patole SK, Whitehall JS (2002) Intravenous rifampicin in neonates with persistent staphylococcal bacteraemia. Acta Paediatr 91:670–673
Soraisham AS, Al-Hindi MY (2008) Intravenous rifampicin for persistent staphylococcal bacteremia in premature infants. Pediatr Int 50:124–126
Strunk T, Richmond P, Simmer K, Currie A, Levy O, Burgner D (2007) Neonatal immune responses to coagulase-negative staphylococci. Curr Opin Infect Dis 20:370–375
Tan TQ, Mason EO Jr, Ou CN, Kaplan SL (1993) Use of intravenous rifampin in neonates with persistent staphylococcal bacteremia. Antimicrob Agents Chemother 37:2401–2406
Van der Lugt NM, Steggerda SJ, Walther FJ (2010) Use of rifampin in persistent coagulase negative staphylococcal bacteremia in neonates. BMC Pediatr 10:84
Conflict of interest
The authors report no conflict of interest or financial interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rodriguez-Guerineau, L., Salvia-Roigés, M.D., León-Lozano, M. et al. Combination of vancomycin and rifampicin for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates. Eur J Pediatr 172, 693–697 (2013). https://doi.org/10.1007/s00431-012-1927-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1927-x