Department of Neonatology, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic- Hospital Sant Joan de Déu, University of Barcelona, Villarroel No. 170, 08036 Barcelona, Spain.
Eur J Pediatr. 2013 May;172(5):693-7. doi: 10.1007/s00431-012-1927-x. Epub 2013 Jan 18.
Coagulase-negative staphylococci are the most common cause of late-onset sepsis in premature neonates. The optimal approach in persistent coagulase-negative staphylococcal bacteremia, despite adequate treatment with glycopeptides, is not well established. A retrospective study was conducted on preterm neonates with persistent coagulase-negative staphylococcal bacteremia treated with the combination of vancomycin-rifampicin. Ten cases were included, with a median gestational age of 26 weeks (range 24 weeks + 3 days-31 weeks + 4 days, interquartile range 25 weeks + 3 days-29 weeks + 3 days) and a median birth weight of 715 g (range 555-2,030). The median age at the onset of infection was 9 days (range 5-37). The most frequent clinical presentation was apnea or increased ventilatory support. Bacteremia persisted for a median of 9 (range 6-19) days until rifampicin initiation. Bacteremia was resolved in all cases on vancomycin-rifampicin with no serious side effects.
Our study provides data supporting the safety and efficacy of vancomycin-rifampicin combination for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.
凝固酶阴性葡萄球菌是早产儿晚发性败血症的最常见原因。尽管已充分使用糖肽类药物治疗，但凝固酶阴性葡萄球菌持续菌血症的最佳处理方法尚未明确。我们对使用万古霉素-利福平联合治疗的凝固酶阴性葡萄球菌持续菌血症的早产儿进行了一项回顾性研究。
共纳入 10 例胎龄中位数为 26 周（范围 24 周+3 天-31 周+4 天，四分位距 25 周+3 天-29 周+3 天）、出生体重中位数为 715 g（范围 555-2030）的早产儿，其感染发病中位年龄为 9 天（范围 5-37）。最常见的临床表现为呼吸暂停或需要增加通气支持。在开始使用利福平之前，中位持续菌血症时间为 9 天（范围 6-19）。所有患儿均在使用万古霉素-利福平后成功清除菌血症，未出现严重不良反应。
本研究提供的数据支持万古霉素-利福平联合治疗早产儿凝固酶阴性葡萄球菌持续菌血症的安全性和有效性。
