Heterogeneous Vancomycin-Intermediate Coagulase-Negative Staphylococci in Neonates: Does treatment with Linezolid improve outcomes?
Methods: Retrospective cohort study of patients with a central line, ≥ 1 positive blood culture for HCoNS and treated with vancomycin or linezolid (2009-2014), from a level III neonatal intensive care unit. Study outcomes were: CLABSI duration, 7-day and 30-day mortality, thrombocytopenia, early CLABSI recurrence (≤ 2 weeks after first negative blood culture) and late recurrence (> 2 weeks after first negative blood culture). χ2 was done for categorical variables and student t-test for continuous variables.
Results: Eighty nine patients were included; 62.9% (n=56) were treated with vancomycin and 37.1% (n=33) with linezolid. Vancomycin blood levels were done in 54/56 patients; 70.4% reached therapeutic levels during CLABSI treatment. Of all patients, 51.7% were males and 88.8% born < 37 weeks. Median gestational age was 273/7 weeks and median birth weight was 805 g. All patients had similar underlying medical diagnoses; 54% with gastrointestinal conditions before CLABSI onset. Risk factors and clinical manifestations of CLABSI did not differ between groups. One third of patients required inotropes for hemodynamic instability and 19% developed necrotizing enterocolitis during or shortly after CLABSI. Median age at CLABSI was 15 days (2-97). S.epidermidis was causative in 96.6% of cases. Blood culture became negative within 48h of central line removal in 38% of patients. Statistically significant differences between patients treated with vancomycin versus linezolid included 30-day all-cause mortality (16.1% vs 27.3% respectively, p=0.019) and late CLABSI recurrence (66.7% vs 0%, p=0.024). All patients with late recurrences had initially been treated with vancomycin; half had ≥ 2 late recurrences. No significant difference was found for duration of CLABSI, thrombocytopenia, early recurrence, time-to-death or 7-day all-cause mortality.
Conclusion: In our study, vancomycin was as effective as linezolid for treatment of CLABSI caused by HCoNS in neonates. Additionally, we found that linezolid may prevent late CLABSI recurrence.
A. C. Blanchard,
I. Goyer, None
P. Ovetchkine, None
A. Moussa, None
B. Da Silva, None
J. S. Y. Chong, None
C. Quach, None