The Role of Coagulase-negative Staphylococci in Early Onset Sepsis in a Large European Cohort of Very Low Birth Weight Infants

Mularoni, Alessandra; Madrid, Marisela; Azpeitia, A; Soler, A Valls i

doi:10.1097/inf.0000000000000175

Cited by 33 publications

(24 citation statements)

References 15 publications

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“…20 BSI are particularly important because they typically have systemic manifestations and are associated with increased mortality. 21 Additionally, premature infants with BSI are at greater risk for chronic lung disease, 1,22 intraventricular hemorrhage, 23 periventricular leukomalacia, 24 and cerebral palsy or other neurodevelopmental impairments. 25-28 …”

Section: Discussionmentioning

confidence: 99%

Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

Neill

Haithcock

Smith

et al. 2016

Advances in Neonatal Care

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Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership.

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Section: Discussionmentioning

confidence: 99%

Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

Neill

Haithcock

Smith

et al. 2016

Advances in Neonatal Care

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“…1–3 CoNS BSI has been shown to increase the incidence of intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, cerebral palsy, and neurodevelopmental impairment. 4–6 These long-term complications are associated with increased hospital length of stay and increased costs. 7,8 …”

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confidence: 99%

No Survival Benefit With Empirical Vancomycin Therapy for Coagulase-negative Staphylococcal Bloodstream Infections in Infants

Ericson¹,

Thaden

Cross

et al. 2015

Pediatric Infectious Disease Journal

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Background Coagulase-negative Staphylococcus (CoNS) is the most common cause of bloodstream infections (BSI) in hospitalized infants. CoNS BSI is most reliably treated with vancomycin; however, concerns about side effects and promoting resistance often delay empirical vancomycin therapy until culture results become available. Methods All infants with CoNS BSI discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group from 1997–2012 were identified. Empirical vancomycin therapy was defined as vancomycin exposure on the day of the first positive blood culture. Delayed vancomycin therapy was defined as vancomycin exposure 1–3 days after the first positive blood culture. We used multivariable logistic regression with random effects for site to evaluate the association between the use of empirical vancomycin therapy vs. delayed vancomycin therapy and 30-day mortality, controlling for gestational age, small-for-gestational age status, postnatal age on the day of the first positive culture, oxygen requirement, ventilator support, and inotropic support on the day the first positive culture was obtained. Results Of the 4364 infants with CoNS BSI, 2848 (65%) were treated with empirical vancomycin. The median postnatal age at first positive culture was 14 days (interquartile range: 9, 21). Unadjusted 30-day mortality was similar for infants treated with empirical vancomycin and infants treated with delayed vancomycin therapy (166/2848 [6%] vs. 69/1516 [4%]; p=0.08). There was no significant difference in 30-day mortality on multivariable analysis (odds ratio: 1.14 [0.84, 1.56]). The median duration of bacteremia was 1 day longer for infants with delayed vancomycin therapy (4 days [interquartile range 2, 6] vs. 3 days [2, 5]; p<0.0001). Conclusions The median duration of bacteremia was 1 day longer in infants with CoNS BSI who received delayed vancomycin therapy. Despite this finding, empirical vancomycin therapy for CoNS BSI was not associated with improved mortality.

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“…18,33,40 CoNS BSI has been associated with increased morbidity, including intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and cerebral palsy. 25,41,42 Moreover, CoNS sepsis has been shown to increase the incidence of NDI in VLBW infants. 43 However, these Staphylococcal Infections in Infants results were not confirmed in a more recent study including premature infants.…”

Section: Discussionmentioning

confidence: 98%

“…24 Two percent to 22.5% of EOS are caused by CoNS. 3,25,26 After 3 days of life, up to 10% of VLBW infants develop CoNS sepsis, and 50% of late-onset bloodstream infections (BSI) are caused by CoNS. 1,4,27,28 In blood cultures, most commonly identified CoNS species are S. epidermidis, S. haemolyticus, S. warneri.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcal Infections in Infants

Blanchard

Quach

Autmizguine

2015

Clinics in Perinatology

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The Role of Coagulase-negative Staphylococci in Early Onset Sepsis in a Large European Cohort of Very Low Birth Weight Infants

Abstract: VLBW infants with EOS are at an increased risk of mortality and major morbidities. CoNS was a significant cause of sepsis, infants with CoNS were at a similarly high risk of complication of prematurity and mortality as those with EOS caused by other organisms.

Cited by 33 publications

References 15 publications

Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

No Survival Benefit With Empirical Vancomycin Therapy for Coagulase-negative Staphylococcal Bloodstream Infections in Infants

Staphylococcal Infections in Infants

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