High alanine aminotransaminase associated with daptomycin use in a premature infant.

Daptomycin is a cyclic lipopeptide antibiotic, a fermented product derived from Streptomyces roseosporus that is active against gram-positive bacteria. We report on a premature infant who developed hepatotoxicity as an adverse drug reaction after the administration of daptomycin 6 mg per kg per dose every 12 h. The patient had an unexpectedly sharp rise of alanine aminotransaminase, prothrombin time and international normalised ratio on the second day following daptomycin administration. This case illustrates a previously unrecognised adverse drug effect associated with daptomycin use in infants.

Risk factors for intraventricular hemorrhage in premature infants in the central region of Saudi Arabia.

BACKGROUND: Intraventricular hemorrhage (IVH) is a serious complication of premature (<32 weeks) deliveries, especially in very-low-birth-weight (VLBW; <1500 g) neonates. Infants developing severe IVH are more prone to long-term developmental disabilities. Although 62%-79% of women in Saudi Arabia receive antenatal steroids, IVH incidence remains high. We analyzed the risk factors for IVH in preterm VLBW neonates in the central region of Saudi Arabia. METHODS: We included premature infants with IVH (n = 108) and gestational age- and birth weight-matched control group infants (n = 108) admitted to our neonatal intensive care unit. Cases were divided into mild (grades I and II; n = 56) and severe (grades III and IV; n = 52) IVH groups. Association of IVH with risk factors in the first week of life was investigated. RESULTS: The following risk factors were associated with severe IVH: lack of antenatal steroid administration (P < .001), pulmonary hemorrhage (P = .023), inotrope use (P = .032), neonatal hydrocortisone administration (P = .001), and patent ductus arteriosus (PDA) (P = .005). Multivariable logistic regression analysis revealed the following to be significant: lack of antenatal dexamethasone (adjusted odds ratio [aOR]: 0.219, 95% confidence interval [95% CI] 0.087-0.546), neonatal hydrocortisone administration (aOR: 3.519, 95% CI 1.204-10.281), and PDA (aOR: 2.718, 95% CI 1.024-7.210). Low hematocrit in the first 3 days of life was significantly associated with severe IVH (all P < .01). CONCLUSIONS: Failure to receive antenatal dexamethasone, PDA, hydrocortisone administration for neonatal hypotension, and low hematocrit in the first 3 days of life was associated with severe IVH in VLBW neonates. Clinicians and healthcare policy makers should consider these factors during decision-making.

Safety and Efficacy of Daptomycin in Neonates with Coagulase-Negative Staphylococci: Case Series Analysis.

There has been an increase in the prevalence of gram-positive bacteremia in neonates in the last two decades. However, as a consequence of better care, there has been an increase in the survival of premature neonates. Coagulase-negative staphylococci (CoNS) is the most prevalent bacteria, responsible for up to 60% of late-onset sepsis (LOS). Daptomycin, a lipopeptide antimicrobial agent, is active against CoNS. This was an observational, retrospective case series study carried out in the Pediatric Hospital of King Saud Medical City, Riyadh, Saudi Arabia. The medical records of 21 neonates, aged 0-28 days, who were treated in Neonatal Intensive Care Unit (NICU) with intravenous daptomycin as monotherapy or combination therapy for at least 4 days for proven gram-positive infection between June 2019 to July 2020, were included. The median gestational and chronological age were 27 weeks and 5 days, respectively. The most frequent diagnosis in neonates was infective endocarditis (42.9%). Of the 21 patients who received daptomycin therapy, 13 (62%) recovered and 8 died. The clinical cure rate was higher in Staphylococcus hominis (100%) and in patients who received 6 mg/kg/dose twice daily (62.5%). The mean of aspartate aminotransferase significantly elevated after starting daptomycin (p = 0.048). However, no muscular or neurological toxicity of daptomycin was documented in any of the cases. Overall, daptomycin was well tolerated, even with long-term treatment.

A Neonatal Unit Experience with Empiric Antibiotics for Late-onset Neonatal Sepsis: A Retrospective Study.

Neonatal sepsis remains a major cause of morbidity and mortality and warrants the immediate start of appropriate empiric treatment. Thus, this study compared the effectiveness of the 2 antibiotic regimens (cloxacillin-amikacin or cefotaxime-ampicillin) among neonates with late-onset neonatal sepsis. METHODS: We conducted a retrospective cohort study comparing mortality between 2 treatment cohorts of very low birth weight neonates with late-onset sepsis, who had received amikacin-cloxacillin or cefotaxime-ampicillin between January 2014 and December 2017. There were 27 neonates in each treatment arm after 1:1 propensity score matching. Univariate analyses (Chi-square and independent t tests, where appropriate) were performed to determine the association between variables. We determined the hazard ratio for all-cause mortality using the Cox regression model. RESULTS: We identified a total of 132 neonates from the hospital's record. We included 27 neonates each in the amikacin-cloxacillin and cefotaxime-ampicillin groups. Intraventricular hemorrhage, necrotizing enterocolitis, birth weight, and gestational age were significantly associated with mortality (P < 0.05). The risk of mortality was significantly higher in neonates receiving empiric cefotaxime and ampicillin than those receiving amikacin and cloxacillin (hazard ratio: 2.91, 95% confidence interval: 1.17-7.30, P = 0.023). CONCLUSIONS: In our center, amikacin-cloxacillin combination therapy was associated with lower mortality in very low birth weight neonates with late-onset sepsis compared with cefotaxime-ampicillin therapy.