Shortening the Antibiotic Course for the Treatment of Neonatal Coagulase-Negative Staphylococcal Sepsis: Fine with Three Days?

Abstract

Background: The incidence of coagulase-negative staphylococcal (CoNS) sepsis is high in neonatal intensive care units (NICUs) and treatment significantly adds to the antibiotic pressure, increasing the threat of resistance. Because infants recover within 24–48 h, blood cultures are negative within 48 h and CRP normalizes within 72 h, we reduced anti-CoNS treatment from 7 to 3 days in infants with uncomplicated CoNS sepsis. Objectives: The aim of the study was to evaluate the effect of short (3 days) treatment duration for CoNS sepsis. Methods: All infants with CoNS sepsis from January 2006 to September 2010 were evaluated. Before 2008 the duration of anti-CoNS treatment was 7 days, but in 2008 it was reduced to 3 days, provided that infants recovered within 48 h, CRP value decreased, thrombocytes were normal and central venous catheters were either not present or removed. Clinical results of treatment for 3 days were compared with 7 days of treatment. Results: There were 142 infants with CoNS sepsis who were eligible for 3 days of antimicrobial treatment duration, 62 (44%) from the period 2006–2008 were treated over 7 days (Group 1) and 80 (56%) from the period 2008–2010 were treated over 3 days (Group 2). Clinical characteristics were not different between the groups. All infants recovered within 48 h and CoNS sepsis did not relapse. Conclusions: Antibiotic treatment for CoNS sepsis may be shortened to 3 days when clinical improvement is rapid and central lines are not present. Prospective randomized studies are needed to confirm the results of this single-center study. Future studies may reveal the effects on the development of antimicrobial resistance.