Coagulase‐negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia

Abstract

Aim: To determine whether sepsis caused by coagulase‐negative staphylococci (CoNS) is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature newborns. Methods: All newborns born at ±30 wk of gestation at Örebro University Hospital during 1994–2001 with clinical sepsis caused by CoNS (group A, n= 22) or by other bacteria (group B, n= 17) were included and compared with premature newborns without sepsis (group C, n= 53). Clinical sepsis was defined as a positive blood culture (monoculture) plus clinical symptoms and laboratory findings. BPD was defined as treatment with oxygen >21% for at least 28 d. Results: The incidence of BPD differed between the three groups, as follows: CoNS sepsis (A) 64%, other sepsis (B) 41% and control (C) 24%. The difference between the control group and the sepsis groups was highly significant (p= 0.006). In a univariate model the crude estimates of relative risk (RR) for occurrence of BPD increased with presence of sepsis and particularly with presence of sepsis with CoNS (A: RR 2.6, 95% CI 1.5–4.6, p= 0.001; B: RR 1.7, CI 0.8–3.5, p= 0.17). When regression was performed with two additional predictive variables in multivariate models including sepsis, gestational age and mechanical ventilation (group A: RR 1.5, CI 1.1–2.0, p= 0.004; group B: RR 0.9, CI 0.6–1.4, p= 0.67), the estimates were lower. Conclusion: The relative risk for BPD is significantly increased in premature newborns with sepsis caused by CoNS compared with those with sepsis caused by other bacteria and compared with premature newborns with no sepsis.

Colonization pattern of coagulase-negative staphylococci in preterm neonates and the relation to bacteremia

“…Preterm newborns, especially extreme preterm (EPT) infants, are prone to CoNS sepsis, since they are immunologically immature, have pervious skin and mucosal barriers, and are regularly exposed to invasive procedures during neonatal intensive care (1,2). Although the acute mortality is low, CoNS sepsis is associated with a significant increase in acute neonatal morbidity, and most probably contributes to the development of post-inflammatory sequelae such as bronchopulmonary dysplasia and CP syndromes (3)(4)(5).…”

Responsiveness of human monocytes to the commensal bacterium Staphylococcus epidermidis develops late in gestation

“…Extremely preterm infants (<30 wk gestational age (GA)) are uniquely susceptible to SE infection, with 10-60% experiencing at least one episode (3). Although direct mortality from SE infection is lower than that from less common gram-negative bacteria and fungi (4-7), SE septicemia is associated with an increased risk of common adverse outcomes, prolonged hospital stay, and increased costs (8)(9)(10)(11)(12). The immunologic mechanisms underlying this increased susceptibility of preterm infants to SE infections are poorly understood but are important in developing effective preventive and therapeutic interventions.…”

Biomarkers of Neutrophil-Mediated Glutathione and Protein Oxidation in Tracheal Aspirates From Preterm Infants: Association With Bacterial Infection

“…Low biomarker levels could reflect little interaction between neutrophils and adherent S. epidermidis colonizing the tube. However, commensals are not necessarily innocent bystanders and can cause neonatal sepsis (17,33). The possibility that GSA measurements could detect these cases warrants investigation.…”

“…Inflammation is a well-established contributor to BPD, and there is strong evidence that systemic sepsis (2,(15)(16)(17) and nosocomial airway infection (19,29,30) are linked to lung injury. Our findings also suggest an association between positive culture and a higher incidence of BPD.…”

“…Infection causes the sequestration and activation of neutrophils at inflammatory sites, and several studies have shown that systemic sepsis is a risk factor for BPD (2,(15)(16)(17). However, diagnosis of lung infection in ventilated infants is difficult, and the relationship between organisms cultured from ET aspirates and BPD is less clear (18,19).…”