The use and misuse of vancomycin in very low birth weight infants

Objective: To evaluate vancomycin use during late-onset sepsis evaluation in very low birth weight infants (VLBW). Study design: Data on late-onset sepsis and antibiotic use, including vancomycin containing regimens, were analyzed and reported from 53 neonatal intensive care units participating in a randomized placebo-controlled trial of Veronate for VLBW infants. Results: Of 505 infants enrolled in the study, 387 (77%) had at least one evaluation for late-onset sepsis. Of these infants, 108 (28%) had one or more positive blood cultures. Two hundred thirty-three (60%) infants evaluated for late-onset sepsis received empiric vancomycin. Twenty-one of 33 neonatal intensive care units included vancomycin as empiric therapy more than 50% of the time. Conclusions: Vancomycin exposure rates for first evaluations of late-onset sepsis are high. Strategies to optimize antibiotic use should minimize consequences of late-onset sepsis while limiting antibiotic pressure for development of resistance.