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Use of intravenous rifampin in neonates with persistent staphylococcal bacteremia
1Department of Pediatrics, Baylor College of Medicine and Infectious Disease Laboratory, Texas Children's Hospital, Houston 77030.
Insights
Rifampin combined with vancomycin effectively treated persistent staphylococcal bacteremia in neonates. This combination therapy demonstrated safety and efficacy, leading to rapid clearance of bacteria in most infants.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Persistent staphylococcal bacteremia in neonates poses a significant clinical challenge.
- Standard antibiotic therapy, including vancomycin, may be insufficient for eradicating staphylococcal infections in this population.
Purpose of the Study:
- To evaluate the safety and efficacy of intravenous (i.v.) rifampin in combination with vancomycin for treating persistent staphylococcal bacteremia in neonates.
- To assess the impact of rifampin on bacterial clearance and patient outcomes.
Main Methods:
- A retrospective study of ten neonates with persistent staphylococcal bacteremia treated with i.v. rifampin and vancomycin.
- Analysis of blood culture results, clinical outcomes, and adverse events.
- Pharmacokinetic analysis of rifampin serum concentrations in a separate cohort of eight infants receiving i.v. or oral rifampin.
Main Results:
- 80% of neonates achieved sterile blood cultures within 24 hours of initiating rifampin therapy.
- No adverse effects were observed in the neonates treated with rifampin.
- Seven out of ten neonates survived the infection, with three deaths attributed to unrelated complications.
Conclusions:
- Intravenous rifampin appears to be a safe and effective adjunctive therapy for persistent staphylococcal bacteremia in neonates.
- Rifampin can rapidly clear bacteria in neonates who have failed to respond to vancomycin alone.
- Further research is warranted to confirm these findings in larger cohorts.
Abstract:
Ten neonates with persistent staphylococcal bacteremia (positive blood cultures for > or = 5 days despite appropriate antibiotic therapy) received intravenous (i.v.) rifampin in combination with vancomycin with or without aminoglycoside. Their mean birth weight and length of gestation were 900 g and 27 weeks, respectively. Their ages at the time of infection ranged from 6 to 64 days (mean, 26 days). The staphylococcal isolates were methicillin-resistant Staphylococcus aureus (five isolates), methicillin-susceptible S. aureus (two isolates), and coagulase-negative staphylococci (three isolates). The mean number of bacteremia days prior to administration of i.v. rifampin was 8.3 (range, 5 to 15 days), despite a mean peak vancomycin concentration of 33 micrograms/ml. The dosing of rifampin varied from 2.5 to 10 mg/kg of body weight every 12 h. The mean duration of the rifampin course was 9.7 days (range, 3 to 16 days). Of the 10 neonates, 8 (80%) had sterile blood cultures within 24 h, 1 (10%) had a sterile blood culture within 48 h, and 1 (10%) had a sterile blood culture within 5 days of being placed on i.v. rifampin. No adverse effects were noted in this small group of infants. Seven of the 10 neonates survived; three died from unrelated complications. The MIC ranges of amikacin, vancomycin, and rifampin for the isolates were 2.0 to 16, 0.5 to 2.0, and 0.0013 to 0.04 micrograms/ml, respectively. We also studied eight infants, with a mean age of 23 days, who were receiving i.v. or oral rifampin at a dose of 10 mg/kg/day. For i.v. administration, the peak serum concentration of rifampin (mean +/- standard deviation) was 4.02 +/- 1.22 microgram/ml. The mean trough level at 12 h postifution was 1.11 +/- 0.48 micrograms/ml. For oral administration, the concentrations of rifampin in serum ranged from 0.59 to 2.86 micrograms/ml (mean, 1.86 +/- 0.96 microgram/ml) at 2 h postingestion, increasing to a peak concentration of 2.8 micrograms/ml at 8 h postingestion. The mean 12-h postingestion level was 0.77 +/- 0.03 microgram/ml. From the study of this limited series of neonates, rifampin appears to be a safe and effective addition to therapy when staphylococcal bacteremia is persistent despite vancomycin treatment.