Empiric therapy with vancomycin in the neonatal intensive care unit: let's “get smart” globally!

Coagulase-negative staphylococci (CoNS) remain the most common organisms causing late-onset bloodstream infections (BSIs) among preterm infants in the neonatal intensive care unit (NICU). 1---4 Since the vast majority, if not all, of CoNS isolates are resistant to beta-lactam agents, including the penicillinase-resistant penicillins, vancomycin remains the drug of choice for proven infections.When CoNS emerged in the 1980s as the most frequently detected pathogen among preterm infants in the NICU, 5 many neonatologists and pediatric infectious disease specialists, including one of the authors (PJS), recommended the empiric use of vancomycin along with an aminoglycoside for suspected late-onset sepsis.