Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus [Terapia antimicrobiana empírica para sepse tardia na unidade neonatal com alta prevalência de Staphylococcus coagulase negativo]

Objective the aim of this study was to compare two different empiric treatments for late-onset neonatal sepsis,vancomycin and oxacillin,in a neonatal intensive care unit with a high prevalence of coagulase-negative staphylococcus. methods a cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. data from the medical records of at-risk newborns were collected daily. infections were defined according to the national health surveillance agency criteria. data analysis was performed using an internal program. results there was a significant reduction in the number of staphylococcus aureus infections (p = 0.008),without endocarditis,meningitis,or lower respiratory tract infection,as well as a reduction in the frequency of deaths related to s. aureus infection. there were no significant changes in the incidence of gram-negative bacterial or fungal infections. an increase in coagulase-negative staphylococcus infections was observed (p = 0.022). however,there was no measured increase in related morbidity and mortality. there was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p < 0.001) and an increase of one day in the median number of days of treatment with vancomycin (p = 0.046). conclusions modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in s. aureus infections,as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. as a result,oxacillin can be considered as an effective treatment for late-onset sepsis,making it possible to avoid broad-spectrum antibiotics. © 2016