TOP 53 - Treatment Outcomes of Invasive Infections due to Staphylococcus aureus in the Neonatal Intensive Care Unit (NICU): Can Antibiotic Duration be Shortened?

Publication Number: 1812.TOP 53

Jackson Gamer, Nationwide Children's Hospital, Columbus, OH, United States; Jacqueline Magers, Nationwide Children's Hospital, Columbus, OH, United States; Alexandra Burton, nationwide children's hospital, Westerville, OH, United States; Richard Moraille, Central Ohio Newborn Medicine, Columbus, OH, United States; Natalie O. White, Pediatrix, BEXLEY, OH, United States; Anthony Theile, Nationwide Children's Hospital, Bexley, OH, United States; Jeanette Taveras, Nationwide Children's Hospital, Columbus, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Background: Invasive Staphylococcus aureus infections remain a major cause of morbidity and mortality among infants in the NICU. However, evidence guiding optimal treatment duration in this population is limited. Current guidelines recommend a 14-day antibiotic course for uncomplicated bacteremia due to both methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) S. aureus, based largely on adult and pediatric observational data. Within the Nationwide Children's Hospital (NCH) Neonatal Network, the Neonatal Antimicrobial Stewardship Program (NEO-ASP) recommends a 7-day antibiotic course for uncomplicated S. aureus bacteremia. We report our institutional experience with treatment of all invasive S. aureus infections across all NCH NICUs to inform optimal antibiotic treatment and duration and assess outcomes.

Objective: To describe the clinical characteristics and evaluate antibiotic duration and associated clinical outcomes of invasive S. aureus infections among infants in the NICU

Design/Methods: This is a retrospective cohort study of infants (n=54) admitted to NCH-affiliated NICUs who had a positive blood culture for S. aureus (MSSA [n=43] or MRSA [n=11]) from 2021 to 2025. Microbiologic data were obtained prospectively from NEO-ASP surveillance as well as the hospital’s Microbiology Laboratory. Pertinent demographic, clinical, laboratory, and outcome data were obtained and the extent of the staphylococcal infection was determined from review of the electronic health records. Uncomplicated S. aureus bacteremia was defined as a positive blood culture without evidence of disseminated disease (e.g., endocarditis, meningitis, osteomyelitis). Antibiotic duration and clinical outcomes, including complications, length of stay, and mortality are being analyzed using descriptive statistics and comparative tests. Recurrence of S. aureus bacteremia within 30 days of antibiotic discontinuation is being evaluated by duration of effective antibiotic therapy. Data collection for analysis is complete and statistical analyses will be finalized by January 2026. The study was approved by the NCH Institutional Review Board.