Hospital-acquired bloodstream infections with Staphylococcus epidermidis. Review of 100 cases

Abstract

During a seven-year study period, 1976 to 1982, this prospective surveillance program detected 108 episodes of nosocomial bacteremia caused by coagulase-negative staphylococci (seven per 10,000 admissions). Chart reviews were subsequently performed in 100 patients primarily to define the patient population and determine outcome of infection. Seventy-two patients had at least two culture bottles that showed growth of coagulase-negative staphylococci plus one or more cultures that showed growth at another site or on a vascular catheter. Most of the patients were in the early or later stages of life: 20 were premature infants, 20 additional infants were under one year of age, and 35 patients were 50 years of age or older. Seventy-three patients were in intensive care areas at the time of the infection. The mortality for the 100 patients studied was 34 percent, with a rate of 9 percent per week after infection. Ninety-three patients had arterial or central lines in place prior to bacteremia and, in 36 reviewed, the mean duration of use of each type of catheter (5.1 days or more) was longer than recommended. In 56 percent of 46 catheters cultured semiquantitatively, there was growth of coagulase-negative staphylococci. The presence of coagulase-negative staphylococci in the blood is associated with significant mortality in hospitalized patients. No longer can their presence in the blood be disregarded as mere contaminants, especially in patients in critical care units.