Cloxacillin versus vancomycin for presumed late-onset sepsis in the Neonatal Intensive Care Unit and the impact upon outcome of coagulase negative staphylococcal bacteremia: a retrospective cohort study

BACKGROUND: Coagulase negative staphylococcus (CONS) is the main cause of late-onset sepsis in Neonatal Intensive Care Units (NICU). Although CONS rarely causes fulminant sepsis, vancomycin is frequently used as empiric therapy. Indiscriminate use of vancomycin has been linked to the emergence of vancomycin resistant organisms. The objective of this study was to compare duration of CONS sepsis and mortality before and after implementation of a policy of selective vancomycin use and compare use of vancomycin between the 2 time periods. METHODS: A retrospective study was conducted of infants ≥4 days old, experiencing signs of sepsis with a first positive blood culture for CONS, during two 12-month periods. Late-onset sepsis was treated empirically with vancomycin and gentamicin during period 1, and cloxacillin and gentamicin during period 2. The confidence interval method was used to assess non-inferiority of the outcomes between the two study groups. RESULTS: There were 45 episodes of CONS sepsis during period 1 and 37 during period 2. Duration of sepsis was similar between periods (hazard ratio of 1.00, 95%CI: 0.64, 1.57). One death during period 2 was possibly related to CONS sepsis versus none in period 1. Vancomycin was used in 97.8% of episodes in period 1 versus 81.1% of episodes in period 2. CONCLUSION: Although we failed to show non-inferiority of duration of sepsis in the cloxacillin and gentamicin group compared to the vancomycin and gentamicin group, duration of sepsis was clinically similar. Restricting vancomycin for confirmed cases of CONS sepsis resistant to oxacillin appears effective and safe, and significantly reduces vancomycin use in the NICU

A project feasibility study on Tahanan Ng Batang Lansangan: A home for street children

Project SummaryA) Name of Project Tahanan ng Batang Lansangan . Tahanan ng Batang Lansangan in Filipino terms, means home for street children. The group chose this name since it clearly defines the project\u27s purpose which is to provide a shelter for children who are out in the streets.B) LocationThe project site is at 1148 United Nations Avenue Manila, left side of the main building of Asilo de San Vicente de Paul. Asilo has approximately 300 square meters of idle land, which is the chosen site of the home\u27s structure. The choice of such location stems from the availability of the land and Asilo\u27s willingness to allot the same to provide shelter for street children. Other reasons for the choice of location include the site\u27s convenience for the project\u27s beneficiaries coming from the streets of Metro Manila, an imminent advantage from the fact that Asilo runs a private school where the street children gathered can avail of good education, and the congregation, being the implementor, through the years, have had considerable experience in proceeding with an institution for less fortunate children.C) Descriptive definition of the project1) Related National Program. This project is envisioned to provide a home and education to street children who are orphaned and abandoned, temporary residential care, social services, moral and spiritual value formation in order to enhance the normal functioning of their total being as normal growing children. It is hoped that they may be prepared to cope with the demand of the times and become worthy Christians, productive and contributing members of our society. This service will be facilitated through the construction of a two-story building which will provide home for children. The children who will live in the home will be given the chance to experience family life responsibilities and activities, and hopefully assimilate spiritual, moral and social values which are the foundation of Christian living.2) Project partner Asilo de San Vicente de Paul is an orphanage that has been existing for 104 years. Administered and managed by the Daughters of Charity, this Institution has been providing home, protection, love and concern for the orphaned and abandoned children. Initially starting on July 26, 1885 with 33 wards and entrusting everything to Divine Providence, the orphanage today has grown in the number of clients served not to forget the thousands of wards who have graduated from its nurturance and formation.With this project study, Asilo will carry into effect any findings furnished as practicable, subject to its superior\u27s approval.D) Feasibility CriteriaIn determining the feasibility of the project, the following facts are to be given consideration:a) the demand for it, i.e. the need for center-based program b) the availability of financial support from funding institutions and private sector (ordinary citizens and/or business firms).E. Highlights of the project1) Goal of Project To establish a home for street children who are orphaned and abandoned with a development program to help them grow into mature and responsible adults