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Colonization with slime-positive coagulase-negative staphylococci as a risk factor for invasive coagulase-negative
S L Hall1, R T Hall, W G Barnes
1Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO 64108.
Abstract:
Mucocutaneous cultures obtained at admission and subsequent weekly nasopharyngeal cultures were obtained on 182 infants in the neonatal intensive care unit (NICU) over 3 months to assess whether a relationship existed between colonization with coagulase-negative staphylococci and invasive infection, particularly with respect to slime production. Nasopharyngeal colonization by coagulase-negative staphylococci occurred in a mean of 58% of infants weekly, with an equal prevalence of slime-positive and slime-negative isolates over time. Colonization of the nasopharynx on admission increased from 8.9% of those admitted within the first day of life to 33% of those admitted thereafter (p less than 0.005). The presence of slime-positive coagulase-negative staphylococci on admission was not predictive of later patterns of colonization with respect to slime. Of infants not colonized on admission who had subsequent cultures, 72% became colonized with coagulase-negative staphylococci that were equally likely to be slime-positive or slime-negative. The incidence of invasive infections was 4.4%. Infants with slime-positive mucocutaneous colonization were more likely to develop invasive coagulase-negative staphylococci disease than infants with slime-negative or no colonization (8.4% versus 1.1%; p less than 0.025). The incidence of slime-positive coagulase-negative staphylococci isolates from blood cultures was 6/7 (86%) whereas those from mucocutaneous cultures was 131/260 (50%) (p = 0.06). Colonization with slime-positive coagulase-negative staphylococci is a significant risk factor for developing invasive coagulase-negative staphylococci disease and these organisms are responsible for the majority of coagulase-negative staphylococci invasive infections.
Insights
Slime-producing coagulase-negative staphylococci colonization in neonatal intensive care unit infants significantly increases the risk of invasive disease. These slime-positive bacteria cause most invasive infections in this vulnerable population.
Area of Science:
- Neonatal Intensive Care Unit (NICU) research
- Infectious Diseases
- Microbiology
Background:
- Coagulase-negative staphylococci (CoNS) are a common cause of healthcare-associated infections in neonates.
- Slime production by CoNS is a virulence factor that may be associated with invasive disease.
- Understanding colonization patterns and their link to infection is crucial for preventing neonatal sepsis.
Purpose of the Study:
- To investigate the relationship between mucocutaneous colonization with coagulase-negative staphylococci (CoNS) and invasive CoNS infections in neonatal intensive care unit (NICU) infants.
- To assess the role of slime production by CoNS in predicting invasive infections.
- To determine the prevalence and temporal trends of CoNS colonization in NICU infants.
Main Methods:
- Prospective study involving 182 NICU infants over 3 months.
- Collection of mucocutaneous and weekly nasopharyngeal cultures at admission and throughout the study period.
- Analysis of slime production in CoNS isolates and correlation with invasive infection development.
Main Results:
- Nasopharyngeal CoNS colonization occurred in a mean of 58% of infants weekly, with equal prevalence of slime-positive and slime-negative isolates.
- Colonization on admission was higher in infants admitted after the first day of life (33%) compared to those admitted within the first day (8.9%).
- Infants with slime-positive mucocutaneous colonization had a significantly higher incidence of invasive CoNS disease (8.4%) compared to those with slime-negative or no colonization (1.1%).
Conclusions:
- Colonization with slime-positive coagulase-negative staphylococci is a significant risk factor for developing invasive CoNS disease in NICU infants.
- Slime-positive CoNS are responsible for the majority of invasive CoNS infections observed in this study.
- Early identification and management of slime-positive CoNS colonization may be critical in preventing severe infections in neonates.