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Emergence of coagulase negative staphylococci as major nosocomial bloodstream pathogens
Abstract:
Over an eight year period, 1975 to 1982, 1,843 nosocomial bloodstream infections were identified by routine prospective surveillance at the University of Virginia Hospital (106/10,000 admissions). Despite a decline in overall bloodstream infection rates during the study period (P = .085), bloodstream infections due to gram positive organisms increased from 29 (1975-1978) to 43/10,000 (1979-1982), (P less than 0.001). Notably, rates for coagulase negative staphylococci increased from 5.2 (1975-1978) to 12.4/10,000 (1979-1982), (P less than 0.001). In 1982, coagulase negative staphylococci accounted for 17% of all bloodstream infections and were the most frequently isolated pathogens. Sixty-four percent of patients with coagulase negative staphylococci were in critical care units versus 41% with other bloodstream infections (P less than .05). The recognition of coagulase negative staphylococci as significant bloodstream pathogens markedly alters the clinician's approach to nosocomial septicemia.
Insights
Nosocomial bloodstream infections caused by coagulase-negative staphylococci significantly increased from 1975 to 1982. These bacteria became the most common cause of hospital-acquired bloodstream infections, particularly in critical care units.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Nosocomial bloodstream infections (BSI) represent a significant healthcare challenge.
- Surveillance data from 1975-1982 at the University of Virginia Hospital identified 1,843 BSIs.
- Overall BSI rates showed a slight decline, but gram-positive organism infections rose.
Purpose of the Study:
- To analyze trends in nosocomial bloodstream infections over an eight-year period.
- To identify shifts in causative pathogens, particularly gram-positive organisms.
- To assess the clinical significance of coagulase-negative staphylococci (CoNS) in BSIs.
Main Methods:
- Prospective surveillance for nosocomial bloodstream infections.
- Analysis of infection rates and causative pathogens from 1975 to 1982.
- Statistical comparison of infection rates between different time periods and patient groups.
Main Results:
- Bloodstream infections due to gram-positive organisms increased significantly (P < 0.001).
- Coagulase-negative staphylococci (CoNS) rates rose from 5.2 to 12.4/10,000 admissions (P < 0.001).
- In 1982, CoNS were the most frequent pathogens, accounting for 17% of BSIs, with higher prevalence in critical care units.
Conclusions:
- Coagulase-negative staphylococci have emerged as major pathogens in nosocomial bloodstream infections.
- The increasing incidence of CoNS BSIs necessitates a revised clinical approach to septicemia.
- Hospital epidemiology and surveillance are crucial for tracking and managing evolving infectious threats.