Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 340-348 (doi:10.1542/peds.2005-0333)
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Persistent Bacteremia and Severe Thrombocytopenia Caused by Coagulase-Negative Staphylococcus in a Neonatal Intensive Care Unit

Minesh Khashu, MDa, Horacio Osiovich, MDa, Deborah Henry, BML Scb, Aziz Al Khotani, MBBSa, Alfonso Solimano, MDa and David P. Speert, MDb

a Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
b Division of Infectious and Immunological Diseases, Department of Pediatrics, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada

OBJECTIVE. Coagulase-negative Staphylococcus (CoNS) is the most frequent cause of late-onset sepsis in NICUs, but mortality is rare and morbidity is unusual. We report a new syndrome of CoNS sepsis characterized by significant morbidity and persistent bacteremia despite aggressive antibiotic therapy and no identified focus of infection.

METHODS. We conducted a retrospective review of infants in the NICU with CoNS bacteremia between 2000 and 2002. Statistical analysis included an initial exploratory analysis followed by logistic regression. Microbiological identification of all isolates and molecular typing were performed.

RESULTS. Thirty-one neonates with persistent CoNS bacteremia were compared with 60 randomly selected neonates from a group of 140 with nonpersistent CoNS bacteremia. The clinical manifestations at presentation, gestational ages, and birth weights were similar in the 2 groups. Thrombocytopenia was present in 26 (84%) neonates with persistent CoNS bacteremia but only in 8 (13%) neonates in the nonpersistent group. Central venous catheterization increased the risk for persistent CoNS bacteremia, but 42% of the persistent group was never catheterized. Staphylococcus epidermidis was the most common isolate in both groups. Molecular typing failed to identify a predominant clone.

CONCLUSIONS. The syndrome of persistent CoNS septicemia is remarkable for thrombocytopenia and persistence in the absence of central venous catheterization. Clinical manifestations at presentation and demographic characteristics did not discriminate between the persistent and nonpersistent groups. We did not identify the emergence of a particularly virulent clone, but it is possible that some strains of CoNS have acquired the capacity to persist under different conditions.

Key Words: neonatal sepsis • Staphylococcus epidermidis • DNA fingerprinting

Abbreviations: CoNS—coagulase-negative Staphylococcus • VLBW—very low birth weight • PN—parenteral nutrition • WCC—white cell count • PFGE—pulsed-field gel electrophoresis • RAPD—random amplified polymorphic DNA

Accepted May 2, 2005.




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