Clinical Outcomes With Continuous Nafcillin Infusions in Children

Objectives: The primary objective of this study was to describe the clinical outcomes of continuous nafcillin infusion in pediatric patients.

Methods: This was a retrospective case study performed at a freestanding, tertiary care children's hospital. Subjects were included if they were at least 30 days old and had received more than 1 dose of nafcillin by continuous infusion (CI) between January 1, 2009, and December 31, 2012. Clinical and microbiological data were extracted from the medical record. Documented adverse events potentially associated with nafcillin were recorded. Treatment success was defined by any one of the following outcomes without the presence of conflicting data: microbiological cure, prescriber-documented treatment success, or normalization of abnormal clinical or laboratory parameters.

Results: Forty subjects with a median of 9 (interquartile range [IQR], 2.3-12) years of age were included. Median length of stay (in days) for all indications observed was 7 (IQR, 5-21.8) days. Extended lengths of stay, indicated by ≥10 days, were more common in cases of endocarditis, skin and soft tissue infection, and bacteremia. Adverse reactions were documented in 20% of patients.

Conclusions: In this pediatric study, overall treatment success was observed in 92.5% of patients. Microbiological cure was documented in 91.3% of patients by using follow-up cultures. Length of stay may be positively impacted by CI nafcillin. Continuously infused nafcillin appears to be an acceptable alternative to intermittently infused nafcillin in children. Further studies are needed to address the question of whether clinical outcomes of CI nafcillin are superior to those of conventional infusion.