Clinical outcome of cephalothin (C) versus vancomycin (V) therapy in the treatment of coagulase-negative staphylococcal (CONS) septicemia in neonates: relation to methicillin resistance (MR) and mec A gene carriage (mAGC) of blood isolates. • 1322

Abstract

CONS are the most important causative agents of nosocomial septicemia in neonatal intensive care units with an incidence of 10% in our unit. We use C as primary antibiotic therapy for nosocomial infections, but increasing usage of V was observed during the last few years. This is due to increasing MR of CONS blood isolates, to 72% in 1995. In addition, increasing mAGC, determined by targeted PCR, was noted for CONS blood isolates from 58% in 1986 to 91% in 1995. There is still debate about the use of first generation cephalosporins in the treatment of MR-CONS infections. Therefore, we have evaluated the outcome of C versus V therapy of CONS neonatal septicemia in relation to MR, C susceptibility and mAGC of CONS isolates for 1994 and 1995. Data of 63 CONS septicemia patients (65 episodes) were studied. In 51 (78%) episodes C was used, in 24 of these (36%) as primary therapy, in 27(42%) treatment was switched from C to V, because of susceptibility results in 16 (60%), clinical picture in 7 (26%), combination of these two in 2 (7%) and in 2 (7%) it was not specified. V as primary therapy was used in 14 episodes(22%). In both C and V categories time for clinical recovery was similar(2.1±1.3 and 2.5±2.7 days, resp.) as was time to CRP normalization (5.5±1.8 and 6.5±3.1 days, resp.). In the 24 episodes treated with C these data were similar between C-susceptible (14 episodes) and C-resistant categories (10 episodes) (clinical recovery after 1.9±1.1 and 2.4±1.5 days, resp., CRP normal after 5.3±2.2 and 5.6±1.3 days, resp.). In the 27 episodes in which C was switched to V, clinical recovery occurred before switch in 12 (44%). Conclusions: 1. Mec A gene carriage of CONS blood isolates has increased considerably to >90% in 1995. 2. Equal clinical outcome of cephalothin or vancomycin therapy of CONS septicemia in neonates, despite almost universal mec A gene carriage of CONS blood isolates. 3.Cephalothin is a valuable alternative to vancomycin in the treatment of CONS septicemia in neonates.