<i>Staphylococcus epidermidis</i> Sepsis in the Intensive Care Nursery: A Characterization of Risk Associations in Infants <1,000 g

Abstract

We undertook to determine Staphylococcus epidermidis colonization patterns and risks of sepsis in a cohort of 82 consecutive intensive care nursery admissions (birth weight 1,285 ± 57 g), with 24 infants weighing < 1,000 g at birth. Colonization was determined by skin and stool cultures collected at three time points. Multiple neonatal variables were classified into three intervals preceding the time of sample collection including the occurrence of S.epidermidis sepsis. 16 infants (20%) developed S.epidermidis sepsis. 81% of these episodes occurred in infants < 1,000 g. Skin colonization was nearly universal at all sampling points. Rectal colonization was 63.6% initially (10 ± 0.4 days), then declined to 32% by the third sample (37 ± 0.4 days). Neither prevalence of skin nor rectal colonization influenced the incidence of sepsis significantly. Statistically significant risk associations for sepsis for the entire intensive care nursery population included: low birth weight, gestational age, presence of a central line, and delayed feeding. For infants < 1,000 g the occurrence of sepsis during the second study time period (54% of the episodes) was associated with preceding steroid exposure. During the third study time period, birth weight and delayed attainment of full enteral feeds showed a statistically significant association with sepsis. We conclude that infants < 1,000 g are at an increased risk of S.epidermidis sepsis. Extreme immaturity, steroid therapy, and prolonged hyperalimentation are all significant risk associations.

Risk Factors Associated with Development of Persistent Coagulase-Negative Staphylococci Bacteremia in the Neonate and Associated Short-Term and Discharge Morbidities

“…Prolonged use of CVC was associated with persistent CoNS sepsis in our multivariate analysis model and has previously been described as a risk factor for LOS CoNS bacteremia [53] . Our findings are consistent with other studies showing an association with increased length of administration of PN and CoNS bacteremia [24,54,55] . Our data add support to others' recommendations to carefully advance enteral feeds earlier [56] .…”

Epidemiology and Diagnosis of Health Care–Associated Infections in the NICU

“…6,7 Parenteral nutrition is commonly administered to the sickest infants through central venous catheters or peripherally inserted central catheters. The relationship between central line use and increased risk of infection has been demonstrated in multiple studies [9][10][11] ; administration of lipids may be an independent risk factor for bacterial or fungal sepsis. 10 The most common type of health careassociated infection within the NICU is a catheter-associated bloodstream infection.…”

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…In any case, the benefits of antenatal steroids, including decreased mortality, intraventricular hemorrhage, respiratory distress syndrome, and EONS, strongly outweight the risk for LONS. Postnatal systemic steroid treatment has been clearly associated with a higher risk of sepsis in preterm infants, with the incidence of LONS increasing to 33% in steroid-treated VLBW infants (228,455,511). While the use of dexamethasone for acute or chronic lung disease has declined due to concerns about adverse neurodevelopmental effects, hydrocortisone use in the most immature VLBW infants with pressor-resistant hypotension and adrenal insufficiency has increased.…”

“…The major species involved in neonatal infection is S. epidermidis, which accounts for approximately 50 to 80% of CoNS colonization (52,185,407) and 60 to 93% of CoNS bloodstream infection (104). S. epidermidis colonization rates of 86 to 100% have been reported among NICU patients (104,138,187,228). Occasionally CoNS is acquired from the mother at birth.…”