1404 What is the Most Appropriate Antibiotic to Treat Late Onset Neonatal Infections?

Abstract

Introduction: Late onset neonatal infection (systemic infection after 48 hours) is an important cause of morbidity and mortality in neonates. Coagulase negative staphylococci (CoNS) is responsible for more than half of these infections but there is no consensus on the most effective antibiotics. Aim: To evaluate the efficacy and suitability of our antibiotic guideline to treat late onset neonatal sepsis and to compare our guidelines with other level 3 neonatal units in UK. Methods: A list of all positive blood culture results were obtained from microbiology department over one year period (June 2008-June 2009). The notes of these babies were reviewed. We also collected data on the antibiotics used in other tertiary NICU in the UK for late onset sepsis. Results: A total of 22 babies were identified with positive blood cultures during their stay in NICU over 1 year period. 18 of these (81%) had grown CONS and 4 grew other organisms including Group B Streptoccci, enterococci and staphylococcus aureus. Of those that grew CoNS, all were sensitive to Vanocomycin. 13/18 (72%) were resistant to flucloxacillin and 10 (55%) were resistant to Gentamycin. Conclusion: Our study indicates that the most commonest organism isolated is CoNS. There is widespread resistance to flucloxacillin and gentamicin. Vancomycin is sensistive in all cases but its use is reserved due to concerns regarding development of resistance. The antibiotics used will depend on the prevalent micro organisms in the area and their resistance. Neonatalologists will need to work with Microbiologists to develop local guidelines.