Need for standardized vancomycin dosing for coagulase-negative staphylococci in hospitalized infants

Abstract

In high-income countries, coagulase-negative staphylococci (CoNS) are the most commonly implicated pathogens in late-onset sepsis (LOS) (sepsis occurring after 72 hours of age) in neonates [ [1] Jean-Baptiste N. Benjamin Jr., D.K. Cohen-Wolkowiez M. Fowler Jr., V.G. Laughon M. Clark R.H. et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2011; 32: 679-686https://doi.org/10.1086/660361 Crossref PubMed Scopus (68) Google Scholar ]. They are responsible for more than 50% of neonatal LOS cases [ [2] Cailes B. Kortsalioudaki C. Buttery J. Pattnayak S. Greenough A. Matthes J. et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018; 103: F547-F553https://doi.org/10.1136/archdischild-2017-313203 Crossref PubMed Scopus (77) Google Scholar ]. Overall mortality rates from LOS caused by CoNS are low; however, low birth-weight and preterm infants carry the highest burden. Morbidity related to LOS caused by CoNS has been associated with poor neurodevelopment, visual impairment, chronic lung disease, and necrotizing enterocolitis and can prolong the length of hospitalization [ [3] Dong Y. Speer C.P. Glaser K. Beyond sepsis: Staphylococcus epidermidis is an underestimated but significant contributor to neonatal morbidity. Virulence. 2018; 9: 621-633https://doi.org/10.1080/21505594.2017.1419117 Crossref PubMed Scopus (47) Google Scholar ]. CoNS are frequently multi-drug resistant, and the emergence of the multi-drug resistant Staphylococcus capitis NRCS-A clone worldwide, found almost exclusively as a pathogen within neonatal units, is concerning [ [4] Laurent F. Butin M. Staphylococcus capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units. Clin Microbiol Infect. 2019; 25: 1081-1085https://doi.org/10.1016/j.cmi.2019.03.009 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ]. A recent survey of French neonatal units demonstrated that S capitis accounted for 14.2% of nosocomial bloodstream infections, with most infections being attributed to the NRCS-A clone [ [5] Decalonne M. Dos Santos S. Gimenes R. Goube F. Abadie G. Aberrane S. et al. Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units. Eur J Clin Microbiol Infect Dis. 2020; 39: 2185-2194https://doi.org/10.1007/s10096-020-03925-5 Crossref PubMed Scopus (1) Google Scholar ].