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March 1990, Vol 144, No. 3 >
Article | March 1990

Extra Hospital Stay and Antibiotic Usage With Nosocomial Coagulase-Negative Staphylococcal Bacteremia in Two Neonatal Intensive Care Unit Populations FREE

Jonathan Freeman, MD, ScD; Michael F. Epstein, MD; Nancy E. Smith, MS; Richard Platt, MD, MS; David G. Sidebottom, MD; Donald A. Goldmann, MD
[+] Author Affiliations

Accepted for publication September 18, 1989.

Presented in part at a joint meeting of the American Pediatric Society and the Society for Pediatric Research, Washington, DC, May 6, 1986.

Reprint requests to West Roxbury VA Hospital, HSR&D 152, 1400 Veterans of Foreign Wars Parkway, West Roxbury, MA 02132 (Dr Freeman).


Am J Dis Child. 1990;144(3):324-329. doi:10.1001/archpedi.1990.02150270074029.
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• Coagulase-negative staphylococci were the leading cause of nosocomial bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and Children's Hospital, Boston, Mass, in 1982. To determine the consequences of these nosocomial bacteremias, a cohort study was conducted in which two comparison subjects were matched with each of 38 bacteremic infants by hospital, birth weight within 100 g, and nearest date of discharge. To adjust for duration of stay in the hospital, it was also required that both comparison subjects have survived and remained in the hospital for as long as the time until bacteremia occurred in the bacteremic infant. The average day of onset of bacteremia was the 20th hospital day. Despite having similar birth weights and comparable severity of underlying illness, bacteremic infants remained in the hospital for an average of 19.8 days longer than the nonbacteremic comparison subjects (77.3 vs 57.5 days). The bacteremic patients received antibiotics for an average of 11.2 more days than the nonbacteremic infants. Vancomycin hydrochloride was given to 20 (52.6%) of the bacteremic patients but only 4 (5.3%) of the comparison patients. All of the comparison subjects and 37 of the 38 infants with bacteremia survived. Thus, nosocomial bacteremia with coagulase-negative staphylococci is a late complication of hospitalization that occurs in infants who are already relatively long-term survivors. This bacteremia appears to be associated with substantially longer hospital stay and antibiotic therapy but little, if any, excess mortality.

(AJDC. 1990;144:324-329)

REFERENCES

1 +
Battisti O, Mitchison R, Davies PO.  Changing blood culture isolates in a referral neonatal intensive care unit . Arch Dis Child . 1981;;56:775-778.
2 +
Munson DP, Thompson TR, Johnson DE, Rhame FS, VanDrunen N, Ferrieri P.  Coagulase-negative staphylococcal septicemia: experience in a newborn intensive care unit . J Pediatr . 1982;;101: 602-605.
3 +
Fleer A, Senders RC, Visser MR, et al.  Septicemia due to coagulase-negative staphylococci in a neonatal intensive care unit: clinical and bacteriological features and contaminated parenteral fluids as a source of sepsis . Pediatr Infect Dis . 1983;;2:426-431.
4 +
Baumgart S, Hall SE, Campos JM, Polin RA.  Sepsis with coagulase-negative staphylococci in critically ill newborns . AJDC . 1983;;137:461-463.
5 +
Cainen G, Campognone P, Peter G.  Coagulase-negative staphylococcal bacteremia in newborns . Clin Pediatr . 1984;;23:542-544.
6 +
Donowitz LG, Haley CE, Gregory WW, Wenzel RP.  Neonatal intensive care unit bacteremia: emergence of gram positive bacteria as major pathogens . Am J Infect Control . 1987;;15:141-147.
7 +
Schmidt BK, Kirplani HM, Corey M, Low DE, Philip AGS, Ford-Jones EL.  Coagulase-negative staphylococci as true pathogens in newborn infants: a cohort study . Pediatr Infect Dis . 1987;;6:1026-1031.
8 +
Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA.  Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population: is there an epidemic? JAMA . 1987;;258:2548-2552.
9 +
Sidebottom DG, Freeman J, Platt R, Epstein MF, Goldmann DG.  A fifteen year experience with blood stream isolates of coagulase-negative staphylococci in neonatal intensive care . J Clin Microbiol . 1988;;26:713-718.
10 +
Freeman J, Platt R, Epstein MF, Sidebottom DG, Goldmann DA. Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding. Am J Epidemiol. In press.
11 +
Lennette EH, Ballows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. Washington, DC: American Society for Microbiology; 1985;.
12 +
Nelson JD.  The neonate . In: Donowitz LG, ed. Hospital-Acquired Infection in the Pediatric Patient . Baltimore, Md: Williams & Wilkins; 1988;:273-294.
13 +
Hemming VG, Overall JC, Britt MR.  Nosocomial infections in a newborn intensive care unit: results of forty-one months of surveillance . N Engl J Med . 1976;;294:1340-1346.
14 +
Goldmann DA, Durbin WA, Freeman J.  Nosocomial infections in a neonatal intensive care unit . J Infect Dis . 1981;;144:449-459.
15 +
Freeman J, Goldmann DA, McGowan JE Jr.  Methodologic issues in hospital epidemiology, IV: risk ratios, confounding, effect modification, and the analysis of multiple variables . Rev Infect Dis . 1988;;10:1118-1141.
16 +
Freeman J, Goldmann DA, Smith NE, Side-bottom DG, Epstein MF, Platt R. Inravenous lipid emulsion as a major determinant of nosocomial coagulase-negative staphylococcal bacteremia in a neonatal intensive care unit population. N Engl J Med. In press.
17 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;.
18 +
Rothman KJ, Boice JD Jr. Epidemiologic Analysis With a Programmable Calculator . Washington, DC: US Dept of Health, Education, and Welfare; 1979;. Publication 1649.
19 +
Snedecor GW, Cochran WG. Statistical Methods . 7th ed. Ames, Iowa: Iowa State University Press; 1980;.
20 +
Akenzua GI, Hui YT, Milner R, Ziparsky A.  Neutrophil and band counts in the diagnosis of neonatal infections . Pediatrics . 1974;;54:38-42.
21 +
Manroe BL, Weinberg AG, Rosenfeld CR, Brown R.  The neonatal blood count in health and disease, I: reference values for neutrophilic cells . J Pediatr . 1979;;95:89-98.
22 +
Rodwell RL, Leslie AL, Tudehope DI.  Early diagnosis of neonatal sepsis using a hematologic scoring system . J Pediatr . 1988;;112:761-767.
23 +
Martin MA, Pfaller MA, Wenzel RP.  Coagulase-negative staphylococcal bacteremia: mortality and hospital stay . Ann Intern Med . 1989;:110:9-16.
24 +
Archer GL.  Coagulase-negative staphylococci in blood cultures: the clinician's dilemma . Infect Control . 1985;;6:477-478.
25 +
Weinstein MP, Reller BL, Murphy JR, Lichtenstein KA.  The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults, I: laboratory and epidemiologic observations . Rev Infect Dis . 1983;;5:35-53.
26 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system . Crit Care Med . 1985;;13:818-829.
27 +
Horn SD, Sharkey PD, Chambers AF, Horn RA.  Severity of illness within DRGs: impact on prospective payment . Am J Public Health . 1985;; 75:1195-1199.
28 +
Georgieff MK, Mills MM, Bhatt P.  Validation of two scoring systems which assess the degree of physiologic instability in critically ill newborn infants . Crit Care Med . 1989;;17:17-21.
29 +
Georgieff MK, Mills MM, Lindeke L, Iverson S, Johnson DE, Thompson TR.  Changes in nutritional management and outcome of very-low-birth-weight infants . AJDC . 1989;;143:82-85.
30 +
Paneth N, Kiely JL, Wallenstein S, Marcus M, Pakter J, Susser M.  Newborn intensive care and neonatal mortality in low-birth-weight infants . N Engl J Med . 1982;;307:149-155.
31 +
Lacouture PG, Epstein MF, Mitchell AA.  Vancomycin-associated shock and rash in newborn infants . J Pediatr . 1987;;11:615-616.
32 +
Hall RT, Hall SL, Barnes WG, Izuegbu J, Rogolsky M, Zorbas I.  Characteristics of coagulase-negative staphylococci from infants with bacteremia . Pediatr Infect Dis . 1987;;6:377-383
33 +
Noel GJ, O'Loughlin JE, Edelson PJ.  Neonatal staphylococcus epidermidis right-sided endocarditis: description of five catheterized infants . Pediatrics . 1988;;82:234-239.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Battisti O, Mitchison R, Davies PO.  Changing blood culture isolates in a referral neonatal intensive care unit . Arch Dis Child . 1981;;56:775-778.
2 +
Munson DP, Thompson TR, Johnson DE, Rhame FS, VanDrunen N, Ferrieri P.  Coagulase-negative staphylococcal septicemia: experience in a newborn intensive care unit . J Pediatr . 1982;;101: 602-605.
3 +
Fleer A, Senders RC, Visser MR, et al.  Septicemia due to coagulase-negative staphylococci in a neonatal intensive care unit: clinical and bacteriological features and contaminated parenteral fluids as a source of sepsis . Pediatr Infect Dis . 1983;;2:426-431.
4 +
Baumgart S, Hall SE, Campos JM, Polin RA.  Sepsis with coagulase-negative staphylococci in critically ill newborns . AJDC . 1983;;137:461-463.
5 +
Cainen G, Campognone P, Peter G.  Coagulase-negative staphylococcal bacteremia in newborns . Clin Pediatr . 1984;;23:542-544.
6 +
Donowitz LG, Haley CE, Gregory WW, Wenzel RP.  Neonatal intensive care unit bacteremia: emergence of gram positive bacteria as major pathogens . Am J Infect Control . 1987;;15:141-147.
7 +
Schmidt BK, Kirplani HM, Corey M, Low DE, Philip AGS, Ford-Jones EL.  Coagulase-negative staphylococci as true pathogens in newborn infants: a cohort study . Pediatr Infect Dis . 1987;;6:1026-1031.
8 +
Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA.  Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population: is there an epidemic? JAMA . 1987;;258:2548-2552.
9 +
Sidebottom DG, Freeman J, Platt R, Epstein MF, Goldmann DG.  A fifteen year experience with blood stream isolates of coagulase-negative staphylococci in neonatal intensive care . J Clin Microbiol . 1988;;26:713-718.
10 +
Freeman J, Platt R, Epstein MF, Sidebottom DG, Goldmann DA. Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding. Am J Epidemiol. In press.
11 +
Lennette EH, Ballows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. Washington, DC: American Society for Microbiology; 1985;.
12 +
Nelson JD.  The neonate . In: Donowitz LG, ed. Hospital-Acquired Infection in the Pediatric Patient . Baltimore, Md: Williams & Wilkins; 1988;:273-294.
13 +
Hemming VG, Overall JC, Britt MR.  Nosocomial infections in a newborn intensive care unit: results of forty-one months of surveillance . N Engl J Med . 1976;;294:1340-1346.
14 +
Goldmann DA, Durbin WA, Freeman J.  Nosocomial infections in a neonatal intensive care unit . J Infect Dis . 1981;;144:449-459.
15 +
Freeman J, Goldmann DA, McGowan JE Jr.  Methodologic issues in hospital epidemiology, IV: risk ratios, confounding, effect modification, and the analysis of multiple variables . Rev Infect Dis . 1988;;10:1118-1141.
16 +
Freeman J, Goldmann DA, Smith NE, Side-bottom DG, Epstein MF, Platt R. Inravenous lipid emulsion as a major determinant of nosocomial coagulase-negative staphylococcal bacteremia in a neonatal intensive care unit population. N Engl J Med. In press.
17 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;.
18 +
Rothman KJ, Boice JD Jr. Epidemiologic Analysis With a Programmable Calculator . Washington, DC: US Dept of Health, Education, and Welfare; 1979;. Publication 1649.
19 +
Snedecor GW, Cochran WG. Statistical Methods . 7th ed. Ames, Iowa: Iowa State University Press; 1980;.
20 +
Akenzua GI, Hui YT, Milner R, Ziparsky A.  Neutrophil and band counts in the diagnosis of neonatal infections . Pediatrics . 1974;;54:38-42.
21 +
Manroe BL, Weinberg AG, Rosenfeld CR, Brown R.  The neonatal blood count in health and disease, I: reference values for neutrophilic cells . J Pediatr . 1979;;95:89-98.
22 +
Rodwell RL, Leslie AL, Tudehope DI.  Early diagnosis of neonatal sepsis using a hematologic scoring system . J Pediatr . 1988;;112:761-767.
23 +
Martin MA, Pfaller MA, Wenzel RP.  Coagulase-negative staphylococcal bacteremia: mortality and hospital stay . Ann Intern Med . 1989;:110:9-16.
24 +
Archer GL.  Coagulase-negative staphylococci in blood cultures: the clinician's dilemma . Infect Control . 1985;;6:477-478.
25 +
Weinstein MP, Reller BL, Murphy JR, Lichtenstein KA.  The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults, I: laboratory and epidemiologic observations . Rev Infect Dis . 1983;;5:35-53.
26 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system . Crit Care Med . 1985;;13:818-829.
27 +
Horn SD, Sharkey PD, Chambers AF, Horn RA.  Severity of illness within DRGs: impact on prospective payment . Am J Public Health . 1985;; 75:1195-1199.
28 +
Georgieff MK, Mills MM, Bhatt P.  Validation of two scoring systems which assess the degree of physiologic instability in critically ill newborn infants . Crit Care Med . 1989;;17:17-21.
29 +
Georgieff MK, Mills MM, Lindeke L, Iverson S, Johnson DE, Thompson TR.  Changes in nutritional management and outcome of very-low-birth-weight infants . AJDC . 1989;;143:82-85.
30 +
Paneth N, Kiely JL, Wallenstein S, Marcus M, Pakter J, Susser M.  Newborn intensive care and neonatal mortality in low-birth-weight infants . N Engl J Med . 1982;;307:149-155.
31 +
Lacouture PG, Epstein MF, Mitchell AA.  Vancomycin-associated shock and rash in newborn infants . J Pediatr . 1987;;11:615-616.
32 +
Hall RT, Hall SL, Barnes WG, Izuegbu J, Rogolsky M, Zorbas I.  Characteristics of coagulase-negative staphylococci from infants with bacteremia . Pediatr Infect Dis . 1987;;6:377-383
33 +
Noel GJ, O'Loughlin JE, Edelson PJ.  Neonatal staphylococcus epidermidis right-sided endocarditis: description of five catheterized infants . Pediatrics . 1988;;82:234-239.

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