Serious infection in a neonatal intensive care unit: A two-year survey

Abstract

SUMMARYOver a two-year period 160 episodes of serious infection occurred in 139 infants admitted to a regional neonatal intensive-care unit. Eighty-seven (26 00) of very low birth weight (VLBW) neonates and 52 (80) of infants of birth weight > 1500 g were infected. The majority (840%) had bacteraemia alone. Though the clinical features of infection were not distinctive, in 940 of episodes the peripheral white blood cell or band counts were abnormal. Thirty-three (21 00) of the infections occurred in infants under 48 h old and 15 of these followed prolonged rupture of membranes (>48 h). All of the infections due to group B streptococci (5), Streptococcus viridans (2) and Haemophilus influenzae (3) occurred in this group.Coagulase-negative staphylococci (CONS) accounted for 490 of the infections and there was a marked increase in incidence of such infections during the survey. Infections with CONS were not necessarily associated with parenteral nutrition, the presence of intra-arterial catheters or mechanical ventilation but the rise in incidence was coincident with change in skin disinfectant usage and the general use of a third-generation cephalosporin to which the CONS were resistant.Although VLBW infants with meningitis were more likely to die than those of higher birthweight, the risk for those with bacteriaemia was the same in both groups. Infants with CONS sepsis were less likely to die than those with infections due to Gram-negative bacteria and the time from onset of infection to death was significantly longer for the former.

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

“…Species of streptococci other than GBS are infrequent agents in EONS in premature neonates and even less common in LONS (Table 2). In the recent NICHD survey, viridans streptococci accounted for 3.6% of cases of EONS (453), and other studies have also reported pathogenicity of these organisms, particularly in premature neonates (147,198). In one study from France, viridans streptococci were associated with neonatal septicemia more frequently than were all other types of streptococci, including GBS (444).…”

Clinical significance of coagulase-negative staphylococci isolated from neonates

“…Somente duas (4,4%) das crianças com infecção por ECN apresentaram idade inferior a dois dias de vida, e destas, uma apresentou ruptura de membrana > que 24 horas, como fator de risco. Resultados similares foram obtidos por Hensey et al 26 , que relataram a ocorrência de somente 12% das infecções por ECN nas primeiras 48 horas de vida, enquanto todas as infecções por Streptococcus do Grupo B, Streptococcus viridans e Haemophilus influenzae ocorreram nesse perío-do e associadas com a rotura prolongada de membrana.…”

Misuse of Antimicrobial Agents in Neonatal Units: A Cross-Sectional Survey in Kuwait

“…These factors were found to be not statistically significant in our study. Most neonatologists do not recommend prophylactic use of antimicrobial agents in many of these risk factors, but rather start them at the earliest definite indication of sepsis [1,4,6,7,[14][15][16]. We strongly support this view.…”

“…Although the degree of the use of antimicrobials has shown a significant contribution to the emergence of resistant organisms, other factors intrinsic to the organisms themselves and to the critically ill patients may play a role [2,14,15]. As the symptomatology for sepsis in neonates is nonspecific, misuse of antimicrobials is much more probable [15][16][17]. In this cross-sectional study, we found that 57/119 (48%) of inpatient neonates were receiving antimicrobial agents and the yield of positive cultures was 25/57 (44%).…”