The Neonatal Antimicrobial Stewardship Program at Nationwide Children's Hospital in 2014 suggested nafcillin above vancomycin for the empirical treatment of potential late-onset sepsis (LOS) in newborns without a history of methicillin-resistant Staphylococcus aureus colonisation or infection.
All 366 infants who received nafcillin or vancomycin for the treatment of potential late-onset sepsis (LOS) at 3 NICUs between January 2013 and May 2014 and January 2017 and March 2019 were retrospectively reviewed for the study.
The duration of blood culture positive, mortality, and return of infection with the same previously diagnosed pathogen within 14 days of stopping antibiotic medication were all considered safety factors.
84 percent (95 of 113) and 25 percent (62 of 253) of the 366 infants who had a first antibiotic course for potential LOS received empirical therapy with vancomycin before and after the implementation of the guidelines, respectively. This represents a reduction of 70 percent. The consumption of nafcillin rose by 368 percent.
Before and after the advice, the time that blood cultures remained positive was the same. Within 14 days of stopping the initial course of treatment for the same infection in 2 infants who had both received empirical vancomycin, antibiotic therapy was restarted.
There was no difference in overall in-hospital mortality before (9%) or after (10%) the vancomycin reduction advice was put into effect (odds ratio, 0.97).
For NICU newborns without a history of methicillin-resistant S aureus infection or colonisation, Nafcillin can be a safe substitute for vancomycin in the treatment of late-onset sepsis (LOS).