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Late-onset neonatal sepsis due to multiply-resistant coagulase-negative staphylococci
1Mater Misericordiae Mothers' Hospital, South Brisbane, QLD.
Abstract:
A cluster of septic episodes that were caused by coagulase-negative staphylococci occurred in eight patients, over a six-month period from August 1, 1984 to January 31, 1985, in a Brisbane neonatal intensive-care unit where sepsis which was due to these organisms previously was uncommon. The organisms were universally-resistant to tobramycin (the aminoglycoside agent that was used at that time) and were variably-resistant to gentamicin, flucloxacillin and cephalothin. All organisms were sensitive to netilmicin, vancomycin, fusidic acid and rifampicin. The affected infants were all of 32 weeks' or less gestation and most of them weighed less than 1500 g at birth. All neonates had been ventilated artificially and had had long intravascular lines. Two infants had ventriculoperitoneal shunts that had been infected with coagulase-negative staphylococci--a potentially-important problem that has not been noted in premature infants in previous reports. Our experience demonstrates that it is important to consider the patterns of resistance to aminoglycoside as well as to beta-lactam antibiotic agents for the empirical therapy of septic episodes and for neurosurgical prophylaxis in nurseries where coagulase-negative staphylococci are emerging as common nosocomial pathogens.
Insights
A rise in coagulase-negative staphylococci sepsis occurred in a neonatal intensive-care unit. This pathogen showed resistance to common antibiotics, necessitating a review of empirical therapy and prophylaxis strategies.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Coagulase-negative staphylococci (CoNS) are an uncommon cause of sepsis in neonatal intensive-care units.
- A cluster of CoNS septic episodes occurred in premature infants over six months.
Purpose of the Study:
- To investigate the antibiotic resistance patterns of CoNS causing neonatal sepsis.
- To inform empirical therapy and neurosurgical prophylaxis in neonatal intensive-care units.
Main Methods:
- Retrospective analysis of eight neonatal septic episodes caused by CoNS.
- Antimicrobial susceptibility testing of isolated CoNS strains.
Main Results:
- CoNS isolates demonstrated universal resistance to tobramycin and variable resistance to gentamicin, flucloxacillin, and cephalothin.
- All isolates were sensitive to netilmicin, vancomycin, fusidic acid, and rifampicin.
- Two premature infants with ventriculoperitoneal shunts developed CoNS sepsis.
Conclusions:
- Emerging CoNS resistance to common antibiotics requires careful consideration for empirical treatment of neonatal sepsis.
- Antibiotic resistance patterns of CoNS should guide prophylaxis strategies in neonatal intensive-care units.
- CoNS infection of ventriculoperitoneal shunts in premature infants is a significant concern.