Risk Factors Associated with Development of Persistent Coagulase-Negative Staphylococci Bacteremia in the Neonate and Associated Short-Term and Discharge Morbidities

Abstract

Background: Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in neonatal intensive care unit settings. Historically, authors have questioned the clinical significance of these bacteremia episodes. Recently, clusters of CoNS bacteremia associated with significant morbidity have been reported. The frequency and importance of these clusters of bacteremia and their associated morbidity remains unclear. Objective: We studied a prolonged cluster of 52 cases of persistent CoNS bacteremia in a level III neonatal intensive care unit to clarify risk factors, morbidity and outcomes associated with persistent CoNS bacteremia. Study Design: A retrospective case-control study of infants with CoNS bacteremia >48 h after initiation of appropriate antibiotics and gestational age-matched control infants was performed. We reviewed patient characteristics prior to and during bacteremia, and outcomes at discharge or death. Results: Persistently infected infants were significantly more likely to have greater duration of exposure to parenteral nutrition, hydrocortisone, antibiotics, and mechanical ventilation prior to infection. Persistently infected infants were significantly more likely than controls to experience feeding intolerance and to require inotropic support, increased respiratory support, and blood product transfusion during bacteremia. Infants with persistent CoNS bacteremia took longer to achieve full enteral feeds, had higher rates of chronic lung disease and increased length of stay compared to controls. No significant difference in mortality was noted. Conclusions: Persistent CoNS bacteremia is associated with clinically significant morbidity including feeding intolerance, respiratory failure, blood transfusion and chronic lung disease in this patient population. This impacts hospital course, increases length of stay and impacts medical needs after discharge. During this study, CoNS bacteremia was difficult to clinically eradicate despite in vitro antibiotic susceptibility.

Neonatal infections in China, Malaysia, Hong Kong and Thailand

“…In CHHP-China, the spectrum of organisms causing neonatal sepsis has a distinctive pattern with CONS being the main pathogen for EOS and LOS. CONS are likely to be true pathogen in preterm infants especially those with a central catheter 24 25. Although the proportion of low birth weight (LBW) among admitted infants was three times higher in CHHP-China than other units, it cannot explain the predominance of CONS in this unit, as most infections in this unit occurred among admitted infants with normal birth weight (see online supplementary table S2).…”

Early-Onset Neonatal Sepsis

“…Echinocandins such as caspofungin (25 mg/m 2 or approximately 2 mg/kg i.v. per dose q24h) have been used effectively in neonatal fungal infections, especially for tissue, bone, and hepatosplenic infections; however, if there are concerns of CNS infection, amphotericin or fluconazole achieves better CNS penetration (249,250,252). Of note, standard deoxycholate amphotericin B and fluconazole remain the preferred treatments of choice over liposomal amphotericin formulations for invasive candidiasis.…”

Prevalence of the Antibiotic Resistance Genes in Coagulase-Positive-and Negative-Staphylococcus in Chicken Meat Retailed to Consumers

“…Although, CNS is recognized as technologically/hygienically very important bacteria in food production and preservation (Hadžiosmanović et al, 2005; Šušković et al, 2010), yet its presence in food is beyond any doubt of public health significance due to the possible promulgation of AMRB and antimicrobial resistant genes (AMRG) (Zdolec et al, 2012a,b, 2013a,b; Dobranić et al, 2013; Chajęcka-Wierzchowska et al, 2015). In previous decades, a continuous loss of susceptibility toward most of the available antibiotics was recorded for CNS with a greater tendency to develop multidrug resistance (Taponen and Pyörälä, 2009) limiting present therapies posing a great threat to the health care system worldwide (Balaban and Rasooly, 2000; Anderson-Berry et al, 2011; deKraker et al, 2011; Jean-Baptiste et al, 2011; Marra et al, 2011). CNS of both animal and human origins are believed to serve as important reservoirs of antimicrobial resistance genes (Becker et al, 2014), which can transfer and integrate into the S. aureus genome leading to the emergence of new, potentially more resistant strains (Otto, 2012; Vitali et al, 2014).…”