Late‐onset infections of infants in neonatal units

Isaacs, David; Barfield, Charles; Clothier, Tors; Darlow, Ben; Diplock, R; Ehrlich, Joshua R.; Grimwood, Keith; Humphrey, I.; Jeffery, Heather; Kohan, Rolland; McNeil, Rosie Thecla; McPhee, Andrew J; Minutillo, Corrado; Morey, Fran; Tudehope, David; Wong, Melanie

doi:10.1111/j.1440-1754.1996.tb00914.x

Cited by 77 publications

(68 citation statements)

References 5 publications

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“…The high frequency of EOS (8%) in our study may be accounted for by the use of a diagnostic procedure less specific than the criteria used in previously published studies. The frequency of LOS was 31% in the 2665 very preterm infants included in our study, a rate consistent with published data (21%-66%), 12,38,39 even though the diagnosis of neonatal infection was not based on highly specific criteria (ie, a positive blood culture result or 2 positive culture results for coagulase-negative staphylococcal infections). 40 The diagnosis of a bloodstream infection in adults is based on a single positive result on blood culture, but this criterion cannot be transposed directly to newborn children in general and to preterm infants in particular.…”

Section: Discussionsupporting

confidence: 78%

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months. WHAT THIS STUDY ADDS:This study assessed the respective effects of early-and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early-and late-onset sepsis were associated. abstract OBJECTIVE: To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children. METHODS:We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models. RESULTS:A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR] CONCLUSIONS: Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS. Pediatrics 2013;132:e372-e380 AUTHORS:

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Section: Discussionsupporting

confidence: 78%

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

et al. 2013

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“…This is in contrast with the findings of our previous studies. 13,14 Like other reports, 1,16,17 the number of CoNS cases in our study was higher than those with S. aureus. It is difficult to determine whether the blood cultures positive for CoNS reflect true infection or contaminants.…”

Section: Discussioncontrasting

confidence: 39%

Experience with Teicoplanin in the Treatment of Neonatal Staphylococcal Sepsis

et al. 2004

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We aimed to evaluate retrospectively the clinical and bacteriological efficacy and potential side-effects of teicoplanin treatment in neonates with proven staphylococcal infection. There were 37 episodes of staphylococcal septicaemia in neonates with a mean gestational age of 34.2 ± 2.3 weeks; 26 were caused by coagulasenegative staphylococcal (CoNS) sepsis and 11 by Staphylococcus aureus sepsis. All episodes were treated with teicoplanin (intravenous loading dose 16 mg/kg followed by a maintenance dose of 8 mg/kg daily). The methicillin resistance and antibiotic susceptibilities of both micro-organisms were evaluated. Bacterial eradication was achieved in 89.1% of cases and mortality was 16.2%. The mean duration of treatment of the survivors was 11.6 ± 2.3 days. There were no drug-related adverse events and the biochemical and haematological tests showed no clinically significant changes in relation to teicoplanin therapy. Our results suggest that teicoplanin is highly effective in neonatal staphylococcal sepsis.

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“…We conclude that the quantity of biofilm produced may be associated with the ability to cause CoNS infection. This conclusion suggests that the regulation of biofilm expression may play a central role in the disease process.Coagulase-negative staphylococci (CoNS) are the major cause of late-onset sepsis in preterm infants (27,39,42,44). Approximately one in six very-low-birth-weight (Ͻ1,500-g) neonates develops an episode of CoNS bacteremia (21, 44), an event that is associated with a significant increase in morbidity and mortality (44), duration of hospital stay (18,21,44), and overall cost of treatment (44).…”

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confidence: 99%

The ica Operon and Biofilm Production in Coagulase-Negative Staphylococci Associated with Carriage and Disease in a Neonatal Intensive Care Unit

et al. 2002

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Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in the neonatal intensive care unit (NICU). We evaluated the hypothesis that the ica operon and biofilm production are associated with CoNS disease in this setting. CoNS associated with bacteremia or blood culture contamination and from the skin of infants with CoNS bacteremia or healthy controls were obtained during a prospective case-control study on a busy NICU. A total of 180 strains were identified, of which 122 (68%) were Staphylococcus epidermidis and the remainder were S. capitis (n ‫؍‬ 29), S. haemolyticus (n ‫؍‬ 11), S. hominis (n ‫؍‬ 9), S. warneri (n ‫؍‬ 8), and S. auricularis (n ‫؍‬ 1). The presence of the genes icaA, icaB, icaC, and icaD was determined by PCR, and biofilm production was examined using qualitative (Congo red agar [CRA]) and quantitative (microtiter plate) techniques. There were no significant differences in the presence of the ica operon or CRA positivity among the four groups of strains. However, quantitative biofilm production was significantly greater in strains isolated from either the blood or the skin of neonates with S. epidermidis bacteremia. We conclude that the quantity of biofilm produced may be associated with the ability to cause CoNS infection. This conclusion suggests that the regulation of biofilm expression may play a central role in the disease process.Coagulase-negative staphylococci (CoNS) are the major cause of late-onset sepsis in preterm infants (27,39,42,44). Approximately one in six very-low-birth-weight (Ͻ1,500-g) neonates develops an episode of CoNS bacteremia (21, 44), an event that is associated with a significant increase in morbidity and mortality (44), duration of hospital stay (18,21,44), and overall cost of treatment (44). There is thus a need to reduce the risk of sepsis in this setting, a goal which depends in part on defining the pathogenesis of infection.The role of biofilm formation as a determinant of CoNS infection has been the subject of ongoing study since the observation that some isolates of Staphylococcus epidermidis produced mucoid growth in vitro that adhered to the walls of culture tubes (2). A series of studies subsequently reported that this material, termed slime, was more commonly produced by isolates associated with sepsis, including intravenous-catheter-related bacteremia and other prosthetic device infections (5,6,10,14,28,31). The relevance to the neonatal intensive care unit (NICU) setting of slime production by CoNS isolates has been studied in relation to both carriage flora and isolates causing infection. The proportion of slime-producing CoNS in carriage flora increased on repeated sampling of neonates during the first 4 weeks of age in one unit (9) but did not vary in two other units over either 2 weeks (35) or a mean of 8 weeks (24). Endemic clones of CoNS that were associated with disease and that were slime producers were demonstrated to persist over a period of 10 years in one unit (26); however, carriage flora was not examined, and an association be...

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Late‐onset infections of infants in neonatal units

Abstract: Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.

Cited by 77 publications

References 5 publications

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

Experience with Teicoplanin in the Treatment of Neonatal Staphylococcal Sepsis

The ica Operon and Biofilm Production in Coagulase-Negative Staphylococci Associated with Carriage and Disease in a Neonatal Intensive Care Unit

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