Vancomycin Prophylaxis for Late-Onset Sepsis in Very Low and Extremely Low Birth Weight Neonates

2008 ◽  
Vol 27 (5) ◽  
pp. 351-354 ◽  
Author(s):  
Susan Givens Bell
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Extremely Low Birth Weight ◽  
Causative Organism ◽  
Published Data ◽  
Late Onset Sepsis ◽  
Elbw Neonates ◽  
Central Catheters

LATE-ONSET SEPSIS AMONG very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates is a troubling occurrence. The most recently published data from the National Nosocomial Infection Surveillance system documents 5.4 umbilical- and central line–related bloodstream infections (BSIs) per 1,000 catheter days in infants weighing between 1,001 and 1,500 g.1 For infants weighing 1,000 g or less, the rate is 9.1 infections per 1,000 catheter days. A variety of factors, including prematurity and related relative immunocompromise, altered skin integrity, and multiple invasive procedures, places VLBW and ELBW neonates at risk for infection. Tunneled central catheters or peripherally inserted central catheters (PICCs) clearly add to the risk of infection in these vulnerable patients. In a point prevalence survey of a network of 29 NICUs, researchers found that coagulase-negative Staphylococcus (CoNS) was the causative organism in nearly half (48.3 percent) of the documented bloodstream infections.2 Vancomycin prophylaxis is a potential strategy for the prevention of late-onset sepsis associated with CoNS. This column explores the efficacy and safety of this strategy.

The concomitant use of vancomycin and piperacillin-tazobactam is associated with acute kidney injury (AKI) in extremely low birth weight infants (ELBW)

2021 ◽  
pp. 1-7
Author(s):  
Y. Al-Jebawi ◽  
K. Karalic ◽  
P. Shekhawat ◽  
M.J. Mhanna
Keyword(s):  
Acute Kidney Injury ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Late Onset ◽  
Kidney Injury ◽  
Extremely Low Birth Weight ◽  
Retrospective Case ◽  
Low Birth Weight Infants ◽  
Late Onset Sepsis ◽  
Increased Risk

BACKGROUND: Late-onset sepsis is common in extremely low birth weight (ELBW) infants, and it leads to the use of antibiotics to cover resistant organisms, which can be nephrotoxic. Here we have investigated the role of vancomycin plus piperacillin-tazobactam on the rate of acute kidney injury (AKI). METHODS: In a retrospective case-control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) with late onset sepsis who were prescribed vancomycin plus piperacillin-tazobactam were reviewed for demographics, clinical characteristics, use of potential nephrotoxic medications and outcomes. RESULTS: During the study period, 264 patients were admitted, of whom 28.4%(75/264) received vancomycin plus piperacillin-tazobactam and were matched with 64 controls. There were no differences in gestational age or birth weight between cases and controls [688±160 vs. 689±162 grams (p = 0.99), and 24.7±1.8 vs. 24.7±1.6 weeks (p = 0.99) respectively]. There was no difference in the rate of sepsis between cases and controls [76%(55/72) vs. 64%(41/64) respectively, p = 0.11]. Infants exposed to vancomycin plus piperacillin-tazobactam had a higher percentage of concomitant use of vasopressors and amphotericin. To adjust for confounders, a logistic regression analysis was conducted with AKI as the dependent variable. Use of vasopressors and vancomycin plus piperacillin-tazobactam were the only risk factors associated with AKI with an adjusted OR (95%CI) of 4.08 (1.90–8.74), p <  0.001; and 2.87 (1.26–6.53), p = 0.01 respectively. CONCLUSION: The use of vancomycin plus piperacillin-tazobactam in ELBW infants is associated with an increased risk for AKI.

scholarly journals Late-Onset Sepsis as a Risk Factor for Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A Nationwide Cohort Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Euiseok Jung ◽  
Byong Sop Lee
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Bronchopulmonary Dysplasia ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Late Onset Sepsis ◽  
The Impact ◽  
Multiple Episodes

Abstract This study aimed to determine the effect of late-onset sepsis (LOS) on the development of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. A prospective cohort study was performed using data collected from 64 centres registered in the Korean national registry. LOS was defined as a positive blood culture and antibiotics treatment after 72 hours of life and prior to 36 weeks postmenstrual age (PMA). Data on the causative organisms were collected and analysed for respiratory outcomes. Among the 1,434 ELBW infants who survived to 36 weeks PMA, 481 (34%) developed LOS caused by bacteria (n = 405), fungi (n = 28), or both (n = 48). The incidence of BPD was significantly associated with LOS in both the entire cohort and the propensity score-matched cohort. Two or more LOS episodes were a risk factor for BPD. The impact of multiple episodes of LOS on BPD was prominent in infants who received mechanical ventilation for two weeks or less. The estimated odds ratios for BPD and severe BPD were greater with fungal LOS than with bacterial LOS. In conclusion, LOS, particularly complicated by multiple episodes and/or fungi, was a risk factor for BPD in ELBW infants.

Parenteral Glutamine Supplementation Does Not Reduce the Risk of Mortality or Late-Onset Sepsis in Extremely Low Birth Weight Infants

PEDIATRICS ◽  
2004 ◽  
Vol 113 (5) ◽  
pp. 1209-1215 ◽  
Author(s):  
B. B. Poindexter ◽  
R. A. Ehrenkranz ◽  
B. J. Stoll ◽  
L. L. Wright ◽  
W. K. Poole ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Glutamine Supplementation ◽  
Low Birth Weight Infants ◽  
Risk Of Mortality ◽  
Late Onset Sepsis

scholarly journals Clinical And Laboratory Findings Of Late Onset Sepsis In Extremely Low Birth Weight Infants According To Causative Organisms

2021 ◽  
Author(s):  
Kyung Hee Park ◽  
Mi Hye Bae ◽  
Na Rae Lee ◽  
Young Mi Han ◽  
Shin-Yun Byun
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Age Of Onset ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Negative Group ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Gram Negative ◽  
Late Onset Sepsis

Abstract Background: Late onset sepsis (LOS) remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important but is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings, when sepsis was suspected in ELBW infants.Methods: A retrospective study was conducted on preterm infants born at less than 28 weeks of gestation with a birth weight of less than 1,000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected LOS were assessed. We classified them into three groups according to blood culture results (gram-positive, gram-negative, and fungal groups) and compared them. Results: A total of 107 patients were included after using the exclusion criteria, with 45 (31.5%) in the gram-positive group, 35 (17.5%) in the gram-negative group, and 27 (11.5%) in the fungal group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than in the bacterial groups. White blood cell (WBC) counts were the highest in the gram-negative group and the lowest in the fungal group. The mean platelet counts were significantly lower in the fungal group (137,000/mm3, 100,000/mm3, and 61,000/mm3 in the gram-positive, gram-negative, and fungal groups, respectively; p< 0.001). C-reactive protein (CRP) levels were significantly higher in the gram-negative group, while glucose was significantly higher in the fungal group. Conclusion: In conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms, in the LOS of ELBW infants. WBC and CRP were increased in gram-negative infection, and thrombocytopenia and hyperglycemia were predominant in fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.

scholarly journals Increased CD11b-Density on Circulating Phagocytes as an Early Sign of Late-Onset Sepsis in Extremely Low-Birth-Weight Infants

2005 ◽  
Vol 57 (2) ◽  
pp. 270-275 ◽  
Author(s):  
Riikka Turunen ◽  
Sture Andersson ◽  
Irmeli Nupponen ◽  
Hannu Kautiainen ◽  
Sanna Siitonen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Late Onset ◽  
Early Sign ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Late Onset Sepsis

scholarly journals Amikacin or Vancomycin Exposure Alters the Postnatal Serum Creatinine Dynamics in Extreme Low Birth Weight Neonates

2021 ◽  
Vol 18 (2) ◽  
pp. 662
Author(s):  
Tamara van Donge ◽  
Anne Smits ◽  
John van den Anker ◽  
Karel Allegaert
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Creatinine ◽  
Potential Effect ◽  
Extremely Low Birth Weight ◽  
Treatment Modalities ◽  
Antibiotic Exposure ◽  
Sensitive Tool ◽  
Elbw Neonates ◽  
The Impact

Background: Disentangling renal adverse drug reactions from confounders remains a major challenge to assess causality and severity in neonates, with additional limitations related to the available tools (modified Kidney Disease Improving Global Outcome, or Division of Microbiology and Infectious Diseases pediatric toxicity table). Vancomycin and amikacin are nephrotoxic while still often prescribed in neonates. We selected these compounds to assess their impact on creatinine dynamics as a sensitive tool to detect a renal impairment signal. Methods: A recently developed dynamical model that characterized serum creatinine concentrations of 217 extremely low birth weight (<1000 g, ELBW) neonates (4036 observations) was enhanced with data on vancomycin and/or amikacin exposure to identify a potential effect of antibiotic exposure by nonlinear mixed-effects modelling. Results: Seventy-seven percent of ELBW patients were exposed to either vancomycin or amikacin. Antibiotic exposure resulted in a modest increase in serum creatinine and a transient decrease in creatinine clearance. The serum creatinine increase was dependent on gestational age, illustrated by a decrease with 56% in difference in serum creatinine between a 24 or 32-week old neonate, when exposed in the 3rd week after birth. Conclusions: A previously described model was used to explore and quantify the impact of amikacin or vancomycin exposure on creatinine dynamics. Such tools serve to explore minor changes, or compare minor differences between treatment modalities.

scholarly journals Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life

2020 ◽  
Author(s):  
Tamara van Donge ◽  
Karel Allegaert ◽  
Verena Gotta ◽  
Anne Smits ◽  
Elena Levtchenko ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Mode Of Delivery ◽  
Extremely Low Birth Weight ◽  
Reference Ranges ◽  
Mixed Effect ◽  
Postnatal Maturation ◽  
Elbw Neonates

Abstract Background Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging. Methods We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated. Results A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth. Conclusions We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.

Sign in / Sign up

Export Citation Format

Share Document