PREVENTION OF GRAM-POSITIVE SEPSIS IN NEONATES WEIGHING LESS-THAN 1500 GRAMS

A prospective, randomized study to evaluate the effectiveness of a con tinuous low-dose vancomycin infusion to prevent nosocomial gram-positi ve bacteremia was initiated within the first 2 weeks of life in neonat es weighing <1500 gm. Seventy-one inf ants received constant infusion of vancomycin (25 mu g/ml) mixed with their total parenteral nutrition solution; 70 infa nts served as control subjects. The groups were cli nically similar in birth weight, estimated gestational age, and severi ty of illness. Administration of vancomycin was begun at a mean age of 5.4 +/- 2.9 days. Infants had mean serum vancomycin concentrations of 2.4 mu g/ml, and received vancomycin for a mean of 11 +/- 7 days. No vancomycin-resistant organisms were detected in surveillance cultures during the 2-year study period. Twenty-four of seventy control infants , in comparison with 1 of 71 infants receiving vancomycin, had gram-po sitive bacteremia (p<0.001). The addition of a low dose of vancomycin to alimentation fluids virtually eliminated the incidence of gram-posi tive bacteremia in an at-risk population of very low birth weight infa nts. However, the widespread use of vancomycin in total parenteral nut rition solution is not recommended until better data on the emergence of vancomycin-resistant organisms are available.