Low mortality in necrotizing enterocolitis associated with coagulase-negative Staphylococcus infection

Abstract

The aim of this study was to correlate the clinical course of necrotizing enterocolitis (NEC) with infection by coagulase-negative Staphylococcus at the onset of the illness. Records of all newborn infants developing NEC between January 1998 and December 2001 were reviewed. NEC was classified according to the criteria of Bell et al. Numeric variables were described by standard statistical methods. Comparisons between subgroups were performed by parametric statistical tests. Forty-four patients developed NEC stage II (n = 25) or III (n = 19). The incidence was 0.024% of live births in the hospital, and the mortality rate was 9%. The main risk factor was prematurity (84%). Only one-fourth of the patients had gastric residuals. A platelet count of <100,000 cells/mm3 occurred only in grade III NEC. Blood cultures were positive in 34% of the patients. The predominant organism (73%) was coagulase-negative Staphylococcus (CoNS). Neither Clostridium nor Bacteroides species were isolated. Stage II patients were maintained nothing per os (NPO) for 9 +/- 3 days and received antibiotics for 10 +/- 3 days. All of the stage III patients required an operation. In one-third of them, primary peritoneal drainage was initially performed but all required further operative procedures. We report a low incidence and mortality rate of necrotizing enterocolitis. Thrombocytopenia is confirmed as a marker of severity. Positive blood cultures for CoNS may explain, at least in part, the low mortality reported.

Coagulase-negative staphylococcus sepsis in preterm infants and long-term neurodevelopmental outcome

“…The crude analysis in our study showed that CoNS sepsis is associated with major NDI in infants born ≤ 28 weeks gestation (25.4% vs. 15.2%; p=0.03), but this association disappeared after adjusting for potential confounders including NEC. The study by Stoll et al did not correct for NEC as a confounder.NEC is known to correlate with CoNS sepsis and affect the neurodevelopmetnal outcome of preterm infants [31,[125][126][127]. In addition, this study reported no difference in cognitive delay between infants exposed and unexposed to CoNS sepsis.…”

Empiric antibiotic regimens for neonatal sepsis in Australian and New Zealand neonatal intensive care units

“…The use of vancomycin may reflect the known association between CoNS and NEC. Similar to CoNS sepsis, NEC associated with CoNS bacteraemia has a low mortality . The long‐term effects of the beta‐lactam/beta‐lactamase inhibitor combination piperacillin‐tazobactam on the development of resistance are not well studied.…”

Staphylococcal Enterocolitis: Forgotten but Not Gone?

“…Coagulase-negative staphylococcal gastrointestinal disease generally occurs in infants less than 4 weeks of age, most of whom were born prematurely (at less than 28 weeks gestation). The most common presentation is a mild, acute enterocolitis [16,17], and presents as abdominal distension and stools with blood and mucus; abdominal radiographs demonstrate diffusely distended bowel loops and bowel wall edema. Less frequently, more severe manifestations including NEC, pneumatosis intestinalis, and bowel perforations develop [18].…”