Advertisement

World Journal of Pediatrics

, Volume 14, Issue 3, pp 269–273 | Cite as

Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants

  • Joseph B. Cantey
  • Kelsey R. Anderson
  • Ram R. Kalagiri
  • Lea H. Mallett
Original Article
  • 137 Downloads

Abstract

Background

Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality.

Methods

This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to examine factors associated with morbidity and mortality.

Results

Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%), Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality [OR 0.6 (95% CI 0.2–2.6)), but sepsis with other organisms was [OR 4.5 (95% CI 2.6–8.0)]. CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hemorrhage, or retinopathy of prematurity.

Conclusion

CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.

Keywords

Morbidity Mortality Neonate Sepsis 

Notes

Author contributions

JBC conceptualized and designed the study, collected data, wrote the first draft of the manuscript, and approved the final version. KRA collected data, assisted with revisions, and approved the final version. RRK helped conceptualize the study, collected data, assisted with revisions, and approved the final version. LHM helped conceptualize and design the study, analyzed the data, assisted with revisions, and approved the final version.

Funding

No funding was secured for this manuscript.

Compliance with ethical standards

Ethical approval

This study was approved by the Institutional Review Board of Baylor Scott & White Health.

Conflcit of interest

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

References

  1. 1.
    Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110:285–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314:1039–51.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Shah J, Jefferies AL, Yoon EW, Lee SK, Shah PS, Canadian Neonatal N. Risk factors and outcomes of late-onset bacterial sepsis in preterm neonates born at < 32 weeks’ gestation. Am J Perinatol. 2015;32:675–82.PubMedGoogle Scholar
  5. 5.
    Mitha A, Foix-L’Helias L, Arnaud C, Marret S, Vieux R, Aujard Y, et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics. 2013;132:e372–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Tolsma KW, Allred EN, Chen ML, Duker J, Leviton A, Dammann O. Neonatal bacteremia and retinopathy of prematurity: the ELGAN study. Arch Ophthalmol. 2011;129:1555–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B, Israel Neonatal N. Pathogen-specific early mortality in very low birth weight infants with late-onset sepsis: a national survey. Clin Infect Dis. 2005;40:218–24.CrossRefPubMedGoogle Scholar
  8. 8.
    Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, Gallagher PG. Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci. J Pediatr. 2015;166:1193–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Martins A, Cunha Mde L. Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci: epidemiological and molecular aspects. Microbiol Immunol. 2007;51:787–95.CrossRefPubMedGoogle Scholar
  10. 10.
    Hsieh EM, Hornik CP, Clark RH, Laughon MM, Benjamin DK Jr, Smith PB, et al. Medication use in the neonatal intensive care unit. Am J Perinatol. 2014;31:811–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics. 2006;117:1979–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Chong J, Quach C, Blanchard AC, Poliquin PG, Golding GR, Laferriere C, et al. Molecular epidemiology of vancomycin-intermediate heteroresistant Staphylococcus epidermidis outbreak in the neonatal intensive care unit. Antimicrob Agents Chemother. 2016;60:5673–81.CrossRefGoogle Scholar
  13. 13.
    Butin M, Rasigade JP, Martins-Simoes P, Meugnier H, Lemriss H, Goering RV, et al. Wide geographical dissemination of the multiresistant Staphylococcus capitis NRCS-A clone in neonatal intensive-care units. Clin Microbiol Infect. 2016;22:46–52.CrossRefPubMedGoogle Scholar
  14. 14.
    Karlowicz MG, Buescher ES, Surka AE. Fulminant late-onset sepsis in a neonatal intensive care unit, 1988-1997, and the impact of avoiding empiric vancomycin therapy. Pediatrics. 2000;106:1387–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Hemels MA, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG. A seven-year survey of management of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit: vancomycin may not be necessary as empiric therapy. Neonatology. 2011;100:180–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Chiu CH, Michelow IC, Cronin J, Ringer SA, Ferris TG, Puopolo KM. Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J. 2011;30:273–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Matrai-Kovalskis Y, Greenberg D, Shinwell ES, Fraser D, Dagan R. Positive blood cultures for coagulase-negative staphylococci in neonates: does highly selective vancomycin usage affect outcome? Infection. 1998;26:85–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Lawrence SL, Roth V, Slinger R, Toye B, Gaboury I, Lemyre B. Cloxacillin versus vancomycin for presumed late-onset sepsis in the Neonatal Intensive Care Unit and the impact upon outcome of coagulase negative staphylococcal bacteremia: a retrospective cohort study. BMC Pediatr. 2005;5:49.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ericson JE, Thaden J, Cross HR, Clark RH, Fowler VG Jr, Benjamin DK Jr, et al. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J. 2015;34:371–5.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rubin LG, Sanchez PJ, Siegel J, Levine G, Saiman L, Jarvis WR, et al. Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists’ practices. Pediatrics. 2002;110:e42.CrossRefPubMedGoogle Scholar
  21. 21.
    Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics. 2012;129:1019–26.CrossRefPubMedGoogle Scholar
  22. 22.
    International Committee for the Classification of Retinopathy of P. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005;123:991–9.CrossRefGoogle Scholar
  23. 23.
    Lee HC, Bennett MV, Schulman J, Gould JB. Accounting for variation in length of NICU stay for extremely low birth weight infants. J Perinatol. 2013;33:872–6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tsai MH, Hsu JF, Chu SM, Lien R, Huang HR, Chiang MC, et al. Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J. 2014;33:e7–13.CrossRefPubMedGoogle Scholar
  25. 25.
    Ballard AR, Mallett LH, Pruszynski JE, Cantey JB. Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort. J Perinatol. 2016;36:1045–8. CrossRefGoogle Scholar
  26. 26.
    Guimaraes H, Rocha G, Vasconcellos G, Proenca E, Carreira ML, Sossai Mdo R, et al. Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units. Rev Port Pneumol. 2010;16:419–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Ohlin A, Bjorkman L, Serenius F, Schollin J, Kallen K. Sepsis as a risk factor for neonatal morbidity in extremely preterm infants. Acta Paediatr. 2015;104:1070–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Cotten CM, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S, et al. Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center. J Perinatol. 2005;25:650–5.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2018

Authors and Affiliations

  • Joseph B. Cantey
    • 1
  • Kelsey R. Anderson
    • 2
  • Ram R. Kalagiri
    • 3
  • Lea H. Mallett
    • 3
  1. 1.Department of PediatricsUniversity of Texas Health Science Center San AntonioSan AntonioUSA
  2. 2.Texas A&M Health Science Center College of MedicineBryanUSA
  3. 3.Texas A&M Health Science CenterBaylor/Scott & White HealthTempleUSA

Personalised recommendations