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Serious postoperative infections caused by coagulase-negative staphylococci: an epidemiological and clinical study
Abstract:
We have reviewed all 3577 nosocomial infections occurring at our institution over a 49-month period and found coagulase-negative staphylococci (CNS) associated with 297. Seventy-eight of 193 CNS tested for antibiotic sensitivity were multiple-drug resistant (MR-CNS). There were 19 well-documented serious postoperative CNS infections including nine ventricular, seven bloodstream and three peritoneal infections. Each was associated with an indwelling device and 11 of the infections involved MR-CNS. Antibiotic therapy with or without removal of the device resulted in cure of all patients. Air samples taken during various surgical procedures frequently were positive for CNS but rarely revealed MR-CNS. Our results cause concern regarding current antibiotic prophylaxis regimens.
Insights
Coagulase-negative staphylococci (CNS) are a significant cause of nosocomial infections, particularly multiple-drug resistant strains (MR-CNS). These infections are often linked to indwelling devices, raising concerns about current antibiotic prophylaxis strategies.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Nosocomial infections pose a significant challenge in healthcare settings.
- Coagulase-negative staphylococci (CNS) are common pathogens in hospital-acquired infections.
- The rise of antibiotic resistance, particularly multidrug resistance (MDR), complicates treatment.
Purpose of the Study:
- To analyze the incidence and characteristics of CNS nosocomial infections over a 49-month period.
- To determine the prevalence of multiple-drug resistant CNS (MR-CNS) in these infections.
- To evaluate the association between CNS infections, indwelling devices, and antibiotic prophylaxis.
Main Methods:
- Retrospective review of 3577 nosocomial infections.
- Identification and antibiotic sensitivity testing of CNS isolates.
- Clinical data review for serious postoperative CNS infections and their management.
Main Results:
- CNS were associated with 297 (8.3%) of nosocomial infections.
- 78 of 193 tested CNS isolates (40.4%) were multidrug resistant (MR-CNS).
- 19 serious postoperative CNS infections were documented, all linked to indwelling devices; 11 involved MR-CNS.
Conclusions:
- Indwelling devices are a major risk factor for serious CNS infections, including those caused by MR-CNS.
- Successful treatment was achieved with antibiotic therapy and/or device removal.
- The frequent presence of CNS in surgical air samples, though rarely MR-CNS, warrants a review of current antibiotic prophylaxis regimens.