PROPHYLACTIC ANTIBIOTIC-TREATMENT FOR PREVENTION OF NOSOCOMIAL SEPSISIN VERY-LOW-BIRTH-WEIGHT (VLBW)-INFANTS

VLBW-infants below 1500 g of birth weight have a quite high risk to ac quire a nosocomial sepsis. 20-40% of all infants exhibit signs of noso comial infection once during neonatal intensive care. The rate of infe ction is related to technique and amount of used invasive devices as t o gestational age. Coagulase-negative staphylococci (CONS) and gram-ne gative organisms contribute most to these cases of sepsis. In a three phase study we tried to demonstrate the efficacy of different mechanis ms to change the rate of nosocomial sepsis. During the first phase a s trict hygienical protocol was enforced as isolation, care with sterile gloves and aseptic techniques in introducing and maintaining i.v. lin es. In a second phase we started a randomized controlled study of prop hylactic vancomycin (10 mg/kg/day in two doses). In a third phase we a dded an oral antibiotic regime with cefixime for all patients with pos itive cultures for gramnegative organisms under the hypothesis of tran slocation from the gut as the way of infection. During the first phase 23.7% of 76 patients enrolled acquired CONS-sepsis, 0.52% gramnegativ e sepsis. During the second phase (41 patients) 6 patients in the cont rol group acquired CONS-sepsis, none in the vancomycin-group. The rate of gramnegative infections was not different (4 and 3 cases). During the third phase (vancomycin plus cefixime eventually in cases of posit ive stool cultures) no case of nosocomial sepsis occurred (35 patients , 11 positive cultures). The management used in phase 3 reduced the ra te of nosocomial infections in VLBW-infants drastically.