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Coagulase-Negative Staphylococcal Infections in the Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Naomi Jean-Baptiste
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina
Daniel K. Benjamin
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina Department of Pediatrics, Duke University, Durham, North Carolina
Michael Cohen-Wolkowiez
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina Department of Pediatrics, Duke University, Durham, North Carolina
Vance G. Fowler
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina Department of Medicine, Duke University, Durham, North Carolina
Matthew Laughon
Affiliation:
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Reese H. Clark
Affiliation:
Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida
P. Brian Smith
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina Department of Pediatrics, Duke University, Durham, North Carolina
Corresponding
E-mail address:

Abstract

Background.

Coagulase-negative staphylococci (CoNS) are the most commonly isolated pathogens in the neonatal intensive care unit (NICU). CoNS infections are associated with increased morbidity, including neurodevelopmental impairment.

Objective.

To describe the epidemiology of CoNS infections in the NICU. To determine mortality among infants with definite, probable, or possible CoNS infections.

Methods.

We performed a retrospective cohort study of all blood, urine, and cerebrospinal fluid cultures from samples obtained from infants aged <121 postnatal days.

Setting.

A total of 248 NICUs managed by the Pediatrix Medical Group from 1997 to 2009.

Results.

We identified 16,629 infants with 17,624 episodes of CoNS infection: 1,734 (10%) definite, 3,093 (17%) probable, and 12,797 (73%) possible infections. Infants with a lower gestational age and birth weight had a higher incidence of CoNS infection. When controlling for gestational age, birth weight, and 5-minute Apgar score, we found that infants with definite, probable, or possible CoNS infection had lower mortality (odds ratio [OR], 0.74 [95% confidence interval {CI}: 0.61, 0.89], 0.68 [95% CI, 0.59, 0.79], and 0.69 [95% CI, 0.63, 0.76], respectively) compared with infants who had negative culture results (P<.001). No significant difference in overall mortality was found in infants who had definite CoNS infection compared with those who had probable or possible CoNS infection (OR, 0.93 [95% CI, 0.75, 1.16] and 0.85 [95% CI, 0.70, 1.03], respectively).

Conclusions.

CoNS infection was strongly related to lower gestational age and birth weight. Infants with clinical sepsis and culture-positive CoNS infection had lower mortality rates than infants with clinical sepsis and negative blood culture results. No difference in mortality between infants with a diagnosis of definite, probable, or possible CoNS infection was observed.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Stoll, BJ, Gordon, T, Korones, SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:6371.CrossRefGoogle ScholarPubMed
2.Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285291.CrossRefGoogle ScholarPubMed
3.Huang, Y, Wang, YH, Chou, YH, Lien, RI. Significance of coagulase-negative staphylococci isolated from a single blood culture from neonates in intensive care. Ann Trop Paediatr 2006;26:311318.CrossRefGoogle ScholarPubMed
4.Isaacs, D. A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units. Arch Dis Child Fetal Neonatal Ed 2003;88:F89F93.CrossRefGoogle Scholar
5.Healy, CM, Palazzi, DL, Edwards, MS, Campbell, JR, Baker, CJ. Features of invasive staphylococcal disease in neonates. Pediatrics 2004;114:953961.CrossRefGoogle ScholarPubMed
6.St Geme, J, Harris, M. Coagulase-negative staphylococcal infection in the neonate. Clin Perinatol 1991;2:281302.Google Scholar
7.Liljedahl, M, Bodin, L, Schollin, J. Coagulase-negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia. Acta Paediatr 2004;93:211215.CrossRefGoogle ScholarPubMed
8.Mittendorf, R, Roizen, N, Moawad, A, Khoshnood, B, Lee, KS. Association between cerebral palsy and coagulase-negative staphylococci. Lancet 1999;354:18751876.CrossRefGoogle ScholarPubMed
9.Stoll, BJ, Hansen, NI, Adams-Chapman, I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:23572365.CrossRefGoogle ScholarPubMed
10.Freeman, J, Epstein, MF, Smith, NE, Platt, R, Sidebottom, DG, Goldmann, DA. Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations. Am J Dis Child 1990;144:324329.Google ScholarPubMed
11.Zaidi, AK, Harrell, LJ, Rost, JR, Reller, LB. Assessment of similarity among coagulase-negative staphylococci from sequential blood cultures of neonates and children by pulsed-field gel electrophoresis. J Infect Dis 1996;174(5):10101014.CrossRefGoogle ScholarPubMed
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis: Mosby; 1996:A1A20.Google Scholar
13.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1996;98:357361.Google ScholarPubMed
14.Rupp, ME, Gordon, LA. Coagulase-negative staphylococci: pathogens associated with medical progress. Clin Infect Dis 1994;19:231243.CrossRefGoogle ScholarPubMed
15.Pfaller, MA, Herwaldt, LA. Laboratory, clinical, and epidemiological aspects of coagulase-negative staphylococci. Clin Microbiol Rev 1988;1:281299.CrossRefGoogle ScholarPubMed
16.Stoll, BJ, Hansen, N, Fanaroff, AA, et al. To tap or not to tap: high likelihood of meningitis without sepsis among very low birth weight infants. Pediatrics 2004;113:11811186.CrossRefGoogle ScholarPubMed
17.Chapman, RL, Faix, RG. Persistently positive cultures and outcome in invasive neonatal candidiasis. Pediatr Infect Dis J 2000;19:822827.CrossRefGoogle ScholarPubMed
18.Chapman, RL, Faix, RG. Persistent bacteremia and outcome in late onset infection among infants in a neonatal intensive care unit. Pediatr Infect Dis J 2003;22:1721.CrossRefGoogle Scholar
19.Bonadio, WA, Smith, DS, Madagame, E, Machi, J, Kini, N. Escherichia coli bacteremia in children: a review of 91 cases in 10 years. Am J Dis Child 1991;145:671674.CrossRefGoogle ScholarPubMed
20.Eppes, S, Troutman, J, Gutman, L. Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr Infect Dis J 1989;8:99104.Google ScholarPubMed
21.Clark, R, Powers, R, White, R, Bloom, B, Sanchez, P, Benjamin, DK Jr. Nosocomial infection in the NICU: a medical complication or unavoidable problem? J Perinatol 2004;24:382388.CrossRefGoogle ScholarPubMed
22.Makhoul, IR, Sujov, P, Smolkin, T, Lusky, A, Reichman, B. Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics 2002;109:3439.CrossRefGoogle ScholarPubMed
23.Rubin, LG, Sánchez, PJ, Siegel, J, Levine, G, Saiman, L, Jarvis, WR; Pediatric Prevention Network. Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists' practices. Pediatrics 2002;110:e42.CrossRefGoogle ScholarPubMed
24.Connell, TG, Rele, M, Cowley, D, Buttery, JP, Curtis, N. How reliable is a negative blood culture result? volume of blood submitted for culture in routine practice in a children's hospital. Pediatrics 2007;119:891896.CrossRefGoogle Scholar
25.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSH surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.CrossRefGoogle Scholar
26.Beekmann, SE, Diekema, DJ, Doern, GV. Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures. Infect Control Hosp Epidemiol 2005;26:559566.CrossRefGoogle Scholar
27.Souvenir, D, Anderson, DE Jr, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:19231926.Google ScholarPubMed
28.Kim, SD, McDonald, LC, Jarvis, WR, McAllister, SK, Jerris, R, Carson, LA, Miller, JM. Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification. Infect Control Hosp Epidemiol 2000;21:213217.CrossRefGoogle Scholar
29.Benjamin, DK Jr, Ross, K, McKinney, RE Jr, Benjamin, DK, Auten, R, Fisher, RG. When to suspect fungal infection in neonates: a clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000;106:712718.CrossRefGoogle ScholarPubMed
30.Thylefors, J, Harbarth, S, Pittet, D. Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality? Infect Control Hosp Epidemiol 1998;8:581589.CrossRefGoogle Scholar
31.Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365369.CrossRefGoogle ScholarPubMed

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