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. 2013 Jul-Sep;25(3):239-44.
doi: 10.5935/0103-507X.20130041.

Healthcare associated infections caused by coagulase-negative Staphylococci in a neonatal intensive care unit

[Article in English, Portuguese]
André Ricardo Araujo da Silva  1 , Maria Luiza Costa de Lima Simões, Lúcia dos Santos Werneck, Cristiane Henriques Teixeira
Affiliations

Healthcare associated infections caused by coagulase-negative Staphylococci in a neonatal intensive care unit

[Article in English, Portuguese]
André Ricardo Araujo da Silva et al. Rev Bras Ter Intensiva. 2013 Jul-Sep.

Abstract
in English, Portuguese

Objective: This study sought to evaluate infections related to health care caused by coagulase-negative Staphylococci in a neonatal intensive care unit by assessing antimicrobial susceptibility profiles and potentially effective antibiotic regimens.

Methods: This was a retrospective descriptive study performed on a case series of healthcare-associated infections, and the antimicrobial susceptibility profiles were evaluated. Newborns from other hospitals who were admitted to a neonatal intensive care unit in Rio de Janeiro between January 1, 2010, and June 30, 2012, were studied.

Results: In total, 765 patients were admitted, totaling 3,051 patient-days, and the incidence density of general infection was 18.9 per 1,000 patient-days. The rate of central venous catheter use was 71.6%, and the positive culture rate for all sites and all infections related to health care were 68.4%. Coagulase-negative Staphylococci were identified in 11 (19.2%) of 57 health care-related infections, and infections with extended-spectrum beta-lactamase producing Klebsiella pneumoniae and Candida sp. constituted 5 cases each. Of the 11 cases of coagulase-negative Staphylococci, 10 (90.9%) were primary bloodstream infections. The sensitivity of the coagulase-negative Staphylococci isolates to vancomycin, clindamycin, ciprofloxacin, oxacillin and gentamycin was 100%, 81.8%, 72.7%, 27.2% and 22.2%, respectively. There were no deaths directly attributed to coagulase-negative Staphylococci infection.

Conclusion: Coagulase-negative Staphylococci was the main agent identified in healthcare-associated infections, with low rates of infections related to central venous catheter. In hospitals with a high oxacillin resistance profile, similar to those included in this study, vancomycin may be used as an initial therapy, although clindamycin represents a viable alternative.

Objetivo: Avaliar as infecções relacionadas à assistência à saúde, em unidade de terapia intensiva neonatal, causadas pelo Staphylococcus coagulase negativa, verificando o perfil de sensibilidade antimicrobiana e possíveis esquemas antibióticos eficazes.

Métodos: Estudo descritivo retrospectivo de uma série de casos de infecções relacionadas à assistência à saúde tardias de origem hospitalar atribuída ao Staphylococcus coagulase negativa, avaliando o perfil de sensibilidade antimicrobiana. Foram estudados os recém-nascidos internados entre 1º de janeiro de 2010 a 30 de junho de 2012 em uma unidade de terapia intensiva neonatal da cidade do Rio de Janeiro, sendo todos os pacientes oriundos de outras unidades.

Resultados: Foram admitidos 765 pacientes, totalizando 3.051 pacientes-dia e uma densidade de incidência de infecção geral de 18,9 por 1.000 pacientes-dia. A taxa de utilização de cateteres venosos centrais foi de 71,6% e a positividade das culturas de todos os sítios para todas as infecções relacionadas à assistência à saúde foi de 68,4%. O Staphylococcus coagulase negativa foi implicado em 11 (19,2%) das 57 infecções relacionadas à assistência à saúde e Klebsiela pneumoniae produtor de betalactamase de espectro estendido e Candida sp em 5 ocasiões cada. Das 11 infecções, 10 (90,9%) foram atribuídas a infecções primárias de corrente sanguínea. A sensibilidade dos isolados de Staphylococcus coagulase negativa em relação à vancomicina, clindamicina, ciprofloxacin, oxacilina e gentamicina foi de 100%, 81,8%, 72,7%, 27,2%, 22,2%, respectivamente. Não houve óbito atribuído diretamente à infecção por Staphylococcus coagulase negativa.

Conclusão: O Staphylococcus coagulase negativa foi o principal agente encontrado nas infecções relacionadas à assistência à saúde tardias de origem hospitalar, sendo baixas as taxas de infecções relacionadas a cateter venoso central. Em hospitais semelhantes ao aqui estudado, com elevado perfil de resistência à oxacilina, a vancomicina pode ser utilizada como terapêutica inicial, sendo também a clindamicina uma alternativa viável.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Incidence density of infections related to nosocomial late healthcare, according to weight range. Incidence density of infection (per 1,000 patient-days).
See this image and copyright information in PMC

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