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Septicemia due to coagulase-negative Staphylococcus in a community hospital
Abstract:
The experience with septicemia due to coagulase-negative Staphylococcus at a 623-bed primary care hospital between 1980 and 1984 was reviewed. A total of 38 episodes in 37 patients were documented; data were available on 37 episodes in 36 patients. The organism accounted for 3.8% of all cases of septicemia and 6.7% of cases of nosocomial septicemia and was associated with 0.03% of all admissions. The incidence remained stable over the 5 years. The rate of survival 28 days after the episode was 78%. Most of the episodes (31) originated from infected vascular access sites. Of the 37 isolates 15 (41%), all S. epidermidis, were slime producing. S. epidermidis accounted for 33 of the isolates; of the 33, 5 were methicillin-resistant and slime producing. Various in-vitro susceptibility testing methods and testing for beta-lactamase production yielded conflicting results. Methicillin resistance, slime production and speciation as S. epidermidis were not confirmed as virulence markers. Five patients with methicillin-resistant organisms were treated with cephalosporins, and all recovered. These findings as well as examination of the literature do not support the recommendations that laboratories report such isolates as resistant to all beta-lactam agents and that vancomycin be given in all such infections. The different case mix in community hospitals as compared with university centres results in different patterns of nosocomial infection. Since the community hospital patient population is much larger, more information on the patterns of infections in these centres is needed.
Insights
Coagulase-negative Staphylococcus caused significant septicemia in a community hospital. Most infections originated from vascular access sites, and survival rates were 78%, challenging current treatment guidelines.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Coagulase-negative Staphylococcus (CoNS) is a common cause of nosocomial septicemia.
- Understanding infection patterns in community hospitals is crucial due to differing patient populations.
Purpose of the Study:
- To review the experience with septicemia due to CoNS at a primary care hospital.
- To evaluate virulence markers and treatment outcomes for CoNS septicemia.
- To assess current recommendations for laboratory reporting and treatment of CoNS infections.
Main Methods:
- Retrospective review of 38 episodes of CoNS septicemia in 37 patients (1980-1984).
- Analysis of infection sources, organism characteristics (slime production, methicillin resistance), and patient outcomes.
- Comparison of in-vitro susceptibility testing results and literature review.
Main Results:
- CoNS accounted for 6.7% of nosocomial septicemia cases.
- Most episodes (31/37) originated from infected vascular access sites.
- Survival rate was 78%; methicillin resistance and slime production were not confirmed virulence markers.
- Treatment with cephalosporins for methicillin-resistant CoNS infections resulted in recovery for all five patients.
Conclusions:
- Findings do not support universal reporting of CoNS as resistant to all beta-lactams or routine vancomycin use.
- Treatment strategies should consider specific patient populations and hospital settings.
- Further research on CoNS infection patterns in community hospitals is warranted.