476Heterogeneous Vancomycin-Intermediate Coagulase-Negative Staphylococci in Neonates: Does treatment with Linezolid improve outcomes?
Bibliographic record
Abstract
Background. Heterogeneous vancomycin-intermediate coagulase-negative staphylococci (HCoNS) are emerging pathogens in neonates with central-line associated bloodstream infections (CLABSI). We aimed to compare clinical outcomes of neonates with HCoNS treated with vancomycin vs linezolid. Methods. Retrospective cohort study of patients with a central line, ≥ 1 positive blood culture for HCoNS and treated with vancomycin or linezolid (2009-2014), from a level III neonatal intensive care unit. Study outcomes were: CLABSI duration, 7-day and 30-day mortality, thrombocytopenia, early CLABSI recurrence (≤ 2 weeks after first negative blood culture) and late recurrence (> 2 weeks after first negative blood culture). χ2 was done for categorical variables and student t-test for continuous variables. Results. Eighty nine patients were included; 62.9% (n = 56) were treated with vancomycin and 37.1% (n = 33) with linezolid. Vancomycin blood levels were done in 54/56 patients; 70.4% reached therapeutic levels during CLABSI treatment. Of all patients, 51.7% were males and 88.8% born < 37 weeks. Median gestational age was 273/7 weeks and median birth weight was 805 g. All patients had similar underlying medical diagnoses; 54% with gastrointestinal conditions before CLABSI onset. Risk factors and clinical manifestations of CLABSI did not differ between groups. One third of patients required inotropes for hemodynamic instability and 19% developed necrotizing enterocolitis during or shortly after CLABSI. Median age at CLABSI was 15 days (2-97). S.epidermidis was causative in 96.6% of cases. Blood culture became negative within 48h of central line removal in 38% of patients. Statistically significant differences between patients treated with vancomycin vs linezolid included 30-day all-cause mortality (16.1% vs 27.3% respectively, p = 0.019) and late CLABSI recurrence (66.7% vs 0%, p = 0.024). All patients with late recurrences had initially been treated with vancomycin; half had ≥ 2 late recurrences. No significant difference was found for duration of CLABSI, thrombocytopenia, early recurrence, time-to-death or 7-day all-cause mortality. Conclusion. In our study, vancomycin was as effective as linezolid for treatment of CLABSI caused by HCoNS in neonates. Additionally, we found that linezolid may prevent late CLABSI recurrence. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".