Coagulase-Negative Staphylococcal Infections in the Neonatal Intensive Care Unit

Abstract

Background Coagulase-negative staphylococci (CoNS) are the most commonly isolated pathogens in the neonatal intensive care unit (NICU). CoNS infections are associated with increased morbidity including neurodevelopmental impairment. Objective Describe the epidemiology of CoNS infections in the NICU. Determine mortality among infants with definite, probable, or possible CoNS infections. Methods We performed a retrospective cohort study of all blood, urine, and cerebrospinal fluid cultures from infants <121 postnatal days. Setting 248 NICUs managed by the Pediatrix Medical Group from 1997 to 2009. Results We identified 16,629 infants with 17,624 episodes of CoNS infection: 1734 (10%) definite, 3093 (17%) probable, and 12,797 (73%) possible infections. Infants with lower gestational age and birth weight had a higher incidence of CoNS infection. Controlling for gestational age, birth weight, and 5-minute Apgar score, infants with definite, probable, or possible CoNS infection had lower mortality—OR=0.74 (95% confidence interval; 0.61, 0.89), OR= 0.68 (0.59, 0.79), and OR=0.69 (0.63, 0.76)—compared to infants with negative cultures (P<0.001). No significant difference in overall mortality was found in infants with definite CoNS infection compared to those with probable or possible CoNS infection—OR=0.93 (0.75, 1.16) and OR=0.85 (0.70, 1.03), respectively. Conclusions CoNS infection was strongly related to lower gestational age and birth weight. Infants with clinical sepsis and culture-positive CoNS infection had lower mortality rates than infants with clinical sepsis and negative blood culture results. No difference in mortality between infants diagnosed with definite, probable, or possible CoNS infection was observed.

Nosocomial infections in a neonatal intensive care unit during 16 years: 1997-2012

“…Gram-negative rods are major pathogens of neonatal sepsis in developing countries 10 . In NICUs, following the adoption of sophisticated tertiary neonatal care with a high rate of invasive device use, CoNS stand out as the main agents of neonatal nosocomial sepsis, with Staphylococcus epidermidis the most frequently isolated 11 . Neonatal infection by CoNS is less severe but causes signifi cant morbidity especially among infants of very low birth weight.…”

Healthcare Associated Infection in the Neonatal Intensive Care Unit of King Abdl Aziz Specialist Hospital, Taif, KSA

“…Health care associated sepsis, defined as a positive blood culture taken after 48 hours of admission to NICU with presence of clinical signs that are suggestive of neonatal septicemia [12].…”

“…St pneumoniae, enterococci and Serratia are also involved [10,11]. In spite of the high prevalence and severity of neonatal HAI, the hospital represents a well established reservoir for resistant organisms that makes the problem difficult to control, and neonatal HAI is still a preventable problem, as risk factors can potentially be employed to develop local strategy for prevention [12]. This could be achieved through strict antiseptic measures for environment, staff, equipment, and minimizing invasive procedures [13].…”

Brief communication (Original). Trends in neonatal sepsis in a neonatal intensive care unit in Thailand before and after construction of a new facility

“…This was surprising because Staphylococcus epidermidis is a primary pathogens isolated in LOS rather than EOS and is usually seen between postnatal days 7 and 14, coinciding with the use of interventions such as intravascular catheters and mechanical ventilators. However, because Staphylococcus epidermidis is a component of normal skin flora it can contaminate blood cultures that are drawn peripherally or though venous catheters [29,30]. In this study sepsis was attributed to a commensal species if the infant was symptomatic at the time blood for culture was obtained and later found to be positive for a commensal species.…”