Neonatal Sepsis 2004-2013: The Rise and Fall of Coagulase-Negative Staphylococci

Abstract

Objectives To evaluate data for the period 2004–2013 to identify changes in demographics, pathogens, and outcomes in a single, level IV neonatal intensive care unit (NICU). Study design Sepsis episodes were identified prospectively and additional information obtained retrospectively from infants with sepsis while in the NICU from 2004–2013. Demographics, hospital course, and outcome data were collected and analyzed. Sepsis was categorized as early (≤3 days of life) or late-onset (>3 days of life). Results Four hundred and fifty two organisms were identified from 410 episodes of sepsis in 340 infants. Ninety percent of cases were late-onset. Rates of early-onset sepsis remained relatively static throughout the study period (0.9 per 1000 live births). The majority (60%) of infants with early-onset sepsis were very low birth weight for the first time in decades, and E. coli (45%) replaced GBS (36%) as the most common organism associated with early-onset sepsis. Rates of late-onset sepsis, particularly due to coagulase-negative staphylococci (CoNS), decreased significantly after implementation of several infection prevention initiatives. CoNS was responsible for 31% of all cases from 2004–2009 but accounted for no cases of late-onset sepsis after 2011. Conclusions The epidemiology and microbiology of early- and late-onset sepsis continue to change, impacted by targeted infection prevention efforts. We believe the decrease in sepsis indicates that these interventions have been successful, but additional surveillance and strategies based on evolving trends are necessary.

Changing Trends in Bacterial Spectrum of Neonatal Sepsis at a Tertiary Care Teaching Hospital - 2011 to 2015

“…Various studies have effectively demonstrated that improvement of infection control procedures such as diligent hand hygiene, proper cleaning and disinfection methods and aseptic practices are linked to lower health care associated infection rates as well as reduction in multidrug-resistant organism transmission and acquisition. (25,26) Since this was a retrospective study, analysis of sepsis as early or late onset was not undertaken since these data were not available.…”

Pathogen-Specific Clustering of Nosocomial Blood Stream Infections in Very Preterm Infants

“…20 Rates of BSI by CoNS but not by gram-negative pathogens have been found to decrease following implementation of improved handling of indwelling central lines. 2,3 Second, while looking for in-hospital transmissions, we had no data about the actual physical proximity of infants contracting a BSI with the same pathogen. Infants being cared for in the same department may or may not have shared the same room, the same nurse, or the same ward.…”

“…BSI with the most commonly isolated organisms in BSI, coagulase-negative staphylococci (CoNS) display a rather benign clinical course. 1,2 CoNS are part of the normal skin flora, and rates of BSI with CoNS have been found to decline after implementation of improved handling of central venous lines. 2,3 In contrast, BSIs with Staphylococcus aureus, gram-negative rods, or fungi have a high mortality risk, 4 with Pseudomonas aeruginosa and Serratia marcescens figuring prominently.…”

“…1,2 CoNS are part of the normal skin flora, and rates of BSI with CoNS have been found to decline after implementation of improved handling of central venous lines. 2,3 In contrast, BSIs with Staphylococcus aureus, gram-negative rods, or fungi have a high mortality risk, 4 with Pseudomonas aeruginosa and Serratia marcescens figuring prominently. 2,3,5,6 Horizontal transmissions of these pathogens in NICUs may cause difficult-to-control outbreaks.…”

Innate Immunity and Human Milk MicroRNAs Content: A New Perspective for Premature Newborns

“…However, Haemophilus influenzae and Listeria monocytogenes may also be identified (12,13). In contrast, gram-positive infections mostly, coagulase negative Staphylococci and Staphylococcus aureus, are characteristic of Late-onset neonatal sepsis (LOS) (14)(15)(16). Late-Onset neonatal Sepsis is associated with high mortality due to difficult diagnosis and empirical antibiotic treatment.…”