Neonatal intensive care unit bacteremia: Emergence of gram-positive bacteria as major pathogens

Donowitz, Leigh G.; Haley, Charles E.; Gregory, W W; Wenzel, Richard P.

doi:10.1016/0196-6553(87)90137-4

Cited by 59 publications

(19 citation statements)

References 19 publications

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“…6 CoNS are known pathogens for late-onset sepsis 5,6,9 and CLABSI 15,16 , as well as common blood culture contaminants. 17,18 Healy et al, after applying strict clinical criteria for CoNS-related bacteremia in their NICU, deemed 54 of 149 episodes (36%) contaminants.…”

Section: Discussionmentioning

confidence: 99%

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

Bizzarro

Shabanova

Baltimore

et al. 2015

The Journal of Pediatrics

137

114

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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.

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Section: Discussionmentioning

confidence: 99%

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

Bizzarro

Shabanova

Baltimore

et al. 2015

The Journal of Pediatrics

137

114

View full text Add to dashboard Cite

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“…Intravenous lipid infusions and the presence of a central line were both inde pendent risk factors for CONS sepsis. Donowitz et al [12], also in a case-control study.…”

Section: Discussionmentioning

confidence: 99%

“…We had only a single documented episode of focal infection associated with staphylococcal bacteremia in our cohort, in contrast to the findings of Noel and Edelson [22] who detected focal infection in 43% of their patients with bacteremia. Sev eral risk factors for CONS sepsis have been documented in prior studies [1,5,7,[11][12][13]. In the study performed by Freeman et al [5], risk factors were determined in a case-control fashion after eliminating all infants <700 g from analysis.…”

Section: Discussionmentioning

confidence: 99%

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<i>Staphylococcus epidermidis</i> Sepsis in the Intensive Care Nursery: A Characterization of Risk Associations in Infants <1,000 g

Johnson-Robbins¹,

El-Mohandes²,

Simmens

et al. 1996

Neonatology

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We undertook to determine Staphylococcus epidermidis colonization patterns and risks of sepsis in a cohort of 82 consecutive intensive care nursery admissions (birth weight 1,285 ± 57 g), with 24 infants weighing < 1,000 g at birth. Colonization was determined by skin and stool cultures collected at three time points. Multiple neonatal variables were classified into three intervals preceding the time of sample collection including the occurrence of S.epidermidis sepsis. 16 infants (20%) developed S.epidermidis sepsis. 81% of these episodes occurred in infants < 1,000 g. Skin colonization was nearly universal at all sampling points. Rectal colonization was 63.6% initially (10 ± 0.4 days), then declined to 32% by the third sample (37 ± 0.4 days). Neither prevalence of skin nor rectal colonization influenced the incidence of sepsis significantly. Statistically significant risk associations for sepsis for the entire intensive care nursery population included: low birth weight, gestational age, presence of a central line, and delayed feeding. For infants < 1,000 g the occurrence of sepsis during the second study time period (54% of the episodes) was associated with preceding steroid exposure. During the third study time period, birth weight and delayed attainment of full enteral feeds showed a statistically significant association with sepsis. We conclude that infants < 1,000 g are at an increased risk of S.epidermidis sepsis. Extreme immaturity, steroid therapy, and prolonged hyperalimentation are all significant risk associations.

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“…Furthermore, TPN adversely affects phagocytosis in neutrophils and increases epithelial permeability. [38][39][40] Central venous blood passes through reticuloendothelial cells in the lung reaching the peripheral vein which lead to much less concentration of microorganisms in peripheral blood than the catheter blood. This explains exclusion of two cases that do not fulfill this criterion.…”

Section: Subhani Et Al Postulated That a Higher Infection Ratementioning

confidence: 99%

Central venous catheter-related blood stream infections in neonatal care unit

Badr

Hammad

Salama

et al. 2013

Int. j. infect. control

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The aim of this study was to detect the rate of catheter-related bloodstream infection (CRBSI) in NICU of Mansoura University Children's Hospital and to focus on possible predictors of infection. A cross sectional comparative study was performed to detect the rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence. Blood samples were collected from 111 neonates clinically suspected of septicemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case.CRBSI was confirmed in 69 cases as central blood culture count was more than 3 folds of peripheral blood culture count. Catheter tip culture showed more than 103 CFU/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged catheter stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI. CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI.

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Neonatal intensive care unit bacteremia: Emergence of gram-positive bacteria as major pathogens

Cited by 59 publications

References 19 publications

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

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

<i>Staphylococcus epidermidis</i> Sepsis in the Intensive Care Nursery: A Characterization of Risk Associations in Infants <1,000 g

Central venous catheter-related blood stream infections in neonatal care unit

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