Vancomycin usage in central venous catheters in a neonatal intensive care unit

被引:4
作者
Elhassan, NO [1 ]
Stevens, TP
Gigliotti, F
Hardy, DJ
Cole, CA
Sinkin, RA
机构
[1] Strong Mem Hosp, Golisano Childrens Hosp, Div Neonatol, Dept Pediat, Rochester, NY USA
[2] Strong Mem Hosp, Golisano Childrens Hosp, Div Infect Dis, Dept Pediat, Rochester, NY USA
[3] Strong Mem Hosp, Dept Pharm, Rochester, NY USA
[4] Strong Mem Hosp, Dept Microbiol & Immunol, Rochester, NY USA
关键词
vancomycin; prophylaxis; therapy; percutaneous central venous catheter; central venous catheter infections;
D O I
10.1097/01.inf.0000114907.13300.86
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. We previously reported that vancomycin in hyperalimentation solution reduces catheter-related infections in the neonatal intensive care unit. Since June 1993 vancomycin (25 mug/ml) was routinely added to central venous catheter solutions, primarily hyperalimentation solution. Because the prophylactic use of vancomycin could lead to the emergence of resistant organisms, the decision to discontinue this practice was made in April of 1999. The use of vancomycin was reserved for documented infections with vancomycin-susceptible organisms. Objective. To compare catheter longevity, rate of laboratory-confirmed blood stream infections and total vancomycin exposure between two 18-month periods before and after the cessation of prophylactic vancomycin use. Methods. Data were evaluated for every neonate in whom a percutaneous central venous catheter was placed. Results. There were 394 neonates enrolled. No statistically significant difference was identified between the two periods regarding the mean catheter days or number of catheters per patient. There was a higher rate of Gram-negative laboratory-confirmed blood stream infections during Period I in patients with percutaneous central venous catheters in place. There were more isolates of coagulase-negative staphylococci in Period 11, resulting in more frequent vancomycin therapy institution and thus an overall increase in the amount of vancomycin used in that period Conclusion. Discontinuing the use of prophylactic vancomycin resulted in exposure of fewer neonates to vancomycin but a higher total amount of vancomycin used. The impact of low dose widespread exposure to vancomycin vs. high dose limited exposure on the microbiologic flora in the neonatal intensive care unit should be further examined.
引用
收藏
页码:201 / 206
页数:6
相关论文
共 17 条
  • [1] Selective use of vancomycin to prevent coagulase-negative staphylococcal nosocomial bacteremia in high risk very low birth weight infants
    Baier, RJ
    Bocchini, JA
    Brown, EG
    [J]. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1998, 17 (03) : 179 - 183
  • [2] PERCUTANEOUS CENTRAL VENOUS CATHETERIZATION - 3 YEARS EXPERIENCE IN A NEONATAL INTENSIVE-CARE UNIT
    CHATHAS, MK
    PATON, JB
    FISHER, DE
    [J]. AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1990, 144 (11): : 1246 - 1250
  • [3] Low-dose vancomycin prophylaxis reduces coagulase-negative staphylococcal bacteraemia in very low birthweight infants
    Cooke, RWI
    Nycyk, JA
    Okuonghuae, H
    Shah, V
    Damjanovic, V
    Hart, CA
    [J]. JOURNAL OF HOSPITAL INFECTION, 1997, 37 (04) : 297 - 303
  • [4] EMERGENCE OF VANCOMYCIN-RESISTANT ENTEROCOCCI IN NEW-YORK-CITY
    FRIEDEN, TR
    MUNSIFF, SS
    LOW, DE
    WILLEY, BM
    WILLIAMS, G
    FAUR, Y
    EISNER, W
    WARREN, S
    KREISWIRTH, B
    [J]. LANCET, 1993, 342 (8863) : 76 - 79
  • [5] PREVENTION OF GRAM-POSITIVE SEPSIS IN NEONATES WEIGHING LESS-THAN 1500 GRAMS
    KACICA, MA
    HORGAN, MJ
    OCHOA, L
    SANDLER, R
    LEPOW, ML
    VENEZIA, RA
    [J]. JOURNAL OF PEDIATRICS, 1994, 125 (02) : 253 - 258
  • [6] MOLLER JC, 1992, DEV PHARMACOL THERAP, V19, P178
  • [7] NATARO JP, 1994, J PEDIATR-US, V125, P798, DOI 10.1016/S0022-3476(06)80186-1
  • [8] CAVAL CATHETERIZATION IN THE INTENSIVE-CARE NURSERY - A USEFUL MEANS FOR PROVIDING PARENTERAL-NUTRITION TO THE EXTREMELY LOW-BIRTH-WEIGHT INFANT
    OGATA, ES
    SCHULMAN, S
    RAFFENSPERGER, J
    LUCK, S
    RUSNAK, M
    [J]. JOURNAL OF PEDIATRIC SURGERY, 1984, 19 (03) : 258 - 262
  • [9] SCHMIDT BK, 1987, PEDIATR INFECT DIS J, V6, P1026, DOI 10.1097/00006454-198706110-00004
  • [10] PREVENTION OF CENTRAL VENOUS CATHETER-RELATED COAGULASE-NEGATIVE STAPHYLOCOCCAL SEPSIS IN NEONATES
    SPAFFORD, PS
    SINKIN, RA
    COX, C
    REUBENS, L
    POWELL, KR
    [J]. JOURNAL OF PEDIATRICS, 1994, 125 (02) : 259 - 263