Infection with Coagulase-negative Staphylococci in a Neonatal Intensive Care Unit

Coagulase-negative staphylococci (CNS) are currently the most common pathogens associated with hospital-acquired infection in many neonatal intensive care units. To determine the risk factors and antimicrobial susceptibility of infections with these organisms, we studied 70 infants from whose blood cultures grew CNS; these infants had received the neonatal intensive care at the Veterans General Hospital, Kaohsiung, Taiwan from 1994 to 1998. We considered it infected when the case grew the same isolates from multiple blood cultures and complied with clinical symptom and signs. Twenty-three cases of all were identified representing infection group and forty-seven were contamination group. Logistic regression was then performed to find significant correlates. The factors most significantly related with infection were the indwelling of central venous catheter (p=0.001) and increased C-reactive protein (CRP) (p=0.0001). Most strains (96%) were multiple antibiotic resistance but all were sensitive to vancomycin. After empirical antimicrobial therapy and by removing central venous catheter, we did not discover any directly associated mortality.We concluded that the indwelling of central venous catheter and increased titers of CRP correlate most strongly with true infection rather than contamination. Vancomycin is the only antibiotic with consistent efficacy against CNS.