Abstract
OBJECTIVE: To compare clinical outcomes in neonates receiving empiric vancomycin or nafcillin containing regimens for neonatal late onset sepsis (nLOS). METHODS: This retrospective study evaluated neonates > 72 hours of age initiated on vancomycin/gentamicin (VANC) or nafcillin/gentamicin (NAF) for suspected nLOS. The primary composite endpoint was clinical worsening, defined as a composite of increased respiratory support or vasopressor requirement, both within the first 24 hours, or prolonged bacteremia. Secondary endpoints included acute kidney injury, methicillin-resistant Staphylococcus aureus colonization, deep-seated infection, and mortality. RESULTS: The final cohort included 97 neonates (46 VANC, 51 NAF). There was no difference in the clinical worsening composite (VANC 15.2% vs NAF 15.7%; p = 0.95) or in the individual components of the composite. Secondary endpoints did not yield statistically significant differences. CONCLUSIONS: Use of nafcillin as the Gram-positive empiric treatment agent did not result in increased clinical worsening compared to vancomycin at our institution.