Resistance to antimicrobials and vancomycin treatment in neonatal sepsis in a hospital in Brazil

Abstract

Objective: To describe the antimicrobial resistance profile of strains isolated from neonates with septicemia undergoing vancomycin treatment, to determine the agreement of treatment with guideline and blood cultures, to assess the presence of acute kidney injury (AKI) and the clinical outcome in a hospital in Brazil. Methods: A total of 51 newborns treated with vancomycin were studied in the period from January to December 2017. Treatment assessment was verified by the compliance with the Rational Use and Insurance Policy of Antibiotics in Neonatology and blood culture. The presence of AKI was based on the results of serum creatinine. The data were monitored by the computerized system of the laboratory. Results: The main isolated strain was Staphylococcus (coagulase negative) (82.9%), 93.5% with resistance to oxacillin for early infections and 100% for late infections. The same strain showed 54.8% resistance to gentamicin for cases of early sepsis and 66.6% for late sepsis. There were no cases of resistance to vancomycin. The treatments agreed with the reference protocol in 46.3% and with the results of blood cultures in 56%. Only two cases of AKI are observed. Conclusions: The oxacillin-resistant coagulase-negative staphylococcus strains were the main causes of neonatal sepsis. The use of gentamicin for sensitive strains may reduce the use of vancomycin. The results suggest the need for better standardization of the treatment to reduce the risk of toxicity and rational use of therapeutic resources.