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Escherichia coli and Other Gram...

PEDIATRICS Vol. 106 No. 6 December 2000, pp. 1387-1390

Fulminant Late-Onset Sepsis in a Neonatal Intensive Care Unit, 1988-1997, and the Impact of Avoiding Empiric Vancomycin Therapy

Received Dec 10, 1999; accepted Feb 18, 2000.

M. Gary Karlowicz, E. Stephen Buescher, and Aqil E. Surka

From the Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia.

Objective.  To determine the pathogens associated with fulminant (lethal within 48 hours) late-onset sepsis (occurring after 3 days of age) in a neonatal intensive care unit (NICU) and the frequency of fulminant late-onset sepsis for the most common pathogens.

Methods.  A retrospective study was conducted of sepsis in infants in a NICU over a 10-year period (1988-1997).

Results.  There were 825 episodes of late-onset sepsis occurring in 536 infants. Thirty-four of 49 (69%; 95% confidence interval [CI]: 55%-82%) cases of fulminant late-onset sepsis were caused by Gram-negative organisms, including Pseudomonas sp., 20 (42%); Escherichia coli, 5 (10%); Enterobacter sp., 4 (8%); and Klebsiella sp., 4 (8%). The frequency of fulminant sepsis was highest for Pseudomonas sp., 20 of 36 (56%; 95% CI: 38%-72%) and lowest for coagulase-negative staphylococci, 4 of 277 (1%; 95%CI: 0%-4%). The very low frequency of fulminant sepsis caused by coagulase-negative staphylococci did not increase during the period when oxacillin was used instead of vancomycin as the empiric antibiotic for Gram-positive organisms.

Conclusions.  These data suggest that empiric antibiotics selected for treatment of suspected sepsis in infants >3 days old need to effectively treat Gram-negative pathogens, particularly Pseudomonas sp., because these organisms, although less frequent, are strongly associated with fulminant late-onset sepsis in the NICU. Avoiding empiric vancomycin therapy seemed to be a reasonable approach to late-onset sepsis, because of the very low frequency of fulminant sepsis caused by coagulase-negative staphylococci.  Key words:  sepsis, neonate, Pseudomonas aeruginosa, coagulase-negative staphylococcus.




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