Document Detail

Persistent bacteremia and severe thrombocytopenia caused by coagulase-negative Staphylococcus in a neonatal intensive care unit.
MedLine Citation:
PMID:  16452352     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Coagulase-negative Staphylococcus (CoNS) is the most frequent cause of late-onset sepsis in NICUs, but mortality is rare and morbidity is unusual. We report a new syndrome of CoNS sepsis characterized by significant morbidity and persistent bacteremia despite aggressive antibiotic therapy and no identified focus of infection. METHODS: We conducted a retrospective review of infants in the NICU with CoNS bacteremia between 2000 and 2002. Statistical analysis included an initial exploratory analysis followed by logistic regression. Microbiological identification of all isolates and molecular typing were performed. RESULTS: Thirty-one neonates with persistent CoNS bacteremia were compared with 60 randomly selected neonates from a group of 140 with nonpersistent CoNS bacteremia. The clinical manifestations at presentation, gestational ages, and birth weights were similar in the 2 groups. Thrombocytopenia was present in 26 (84%) neonates with persistent CoNS bacteremia but only in 8 (13%) neonates in the nonpersistent group. Central venous catheterization increased the risk for persistent CoNS bacteremia, but 42% of the persistent group was never catheterized. Staphylococcus epidermidis was the most common isolate in both groups. Molecular typing failed to identify a predominant clone. CONCLUSIONS: The syndrome of persistent CoNS septicemia is remarkable for thrombocytopenia and persistence in the absence of central venous catheterization. Clinical manifestations at presentation and demographic characteristics did not discriminate between the persistent and nonpersistent groups. We did not identify the emergence of a particularly virulent clone, but it is possible that some strains of CoNS have acquired the capacity to persist under different conditions.
Minesh Khashu; Horacio Osiovich; Deborah Henry; Aziz Al Khotani; Alfonso Solimano; David P Speert
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  117     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-02     Completed Date:  2006-02-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  340-8     Citation Subset:  AIM; IM    
Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre, University of British Columbia, Vancouver, British Columbia, Canada.
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MeSH Terms
Bacteremia / complications,  drug therapy,  microbiology*
Coagulase / metabolism*
Cross Infection / drug therapy,  microbiology*
Infant, Newborn
Infant, Very Low Birth Weight
Intensive Care Units, Neonatal
Platelet Transfusion
Risk Factors
Sepsis / diagnosis,  drug therapy,  microbiology
Staphylococcal Infections / complications,  drug therapy,  microbiology*
Staphylococcus / enzymology*
Staphylococcus epidermidis / enzymology
Thrombocytopenia / complications*,  therapy
Reg. No./Substance:
Comment In:
Pediatrics. 2006 Jun;117(6):2330-1   [PMID:  16740890 ]

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