Persistent Bacteremia Due to Coagulase-Negative Staphylococci in Low Birth Weight Neonates

PEDIATRICS ◽  
1989 ◽  
Vol 84 (6) ◽  
pp. 977-985
Author(s):  
Christian C. Patrick ◽  
Sheldon L. Kaplan ◽  
Carol J. Baker ◽  
Joseph T. Parisi ◽  
Edward O. Mason
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Polyacrylamide Gel Electrophoresis ◽  
Sodium Dodecyl ◽  
Clinical Manifestations ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Low Birth Weight Infants ◽  
Persistent Bacteremia ◽  
Intravascular Catheters

During a 6-month period in 1987, 13 low birth weight neonates without indwelling central intravascular catheters had persistent (positive blood cultures for ≥6 days) coagulase-negative staphylococcal bacteremia despite adequate antibiotic therapy. Daily blood cultures remained persistently positive for a mean of 13 days (range 6 to 25 days). This group of infants was compared with other low birth weight infants with similar birth weights and nonpersistent coagulase-negative staphylococcal bacteremia, defined as two or more positive blood cultures accompanied by supporting clinical manifestations of sepsis. During this period, coagulase-negative staphylococcal represented 29% of all bacteremias, and 33% of coagulase-negative staphylococcal bacteremias were persistent. Other than soft tissue abscesses, none of the infants with persistent coagulase-negative staphylococcal bacteremia had a defined focus of infection. Abdominal distention (P= .001) and thrombocytopenia (P<.03) occurred significantly more frequently in the patients with persistent coagulase-negative staphylococcal bacteremia than in those with nonpersistent bacteremia. Of the 13 patients with persistent coagulase-negative staphylococcal bacteremia, 2 received methicillin and 11 received vancomycin. No antibiotic tolerance to either antibiotic could be demonstrated. Serum concentrations of vancomycin far exceeded the minimum bactericidal concentration in all cases in which vancomycin was prescribed. No in vitro differences could be demonstrated between persistent and nonpersistent coagulase-negative staphylococcal strains for slime production, biotype, proteins from modified whole cell lysates developed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and opsonophagocytosis by adult neutrophils in the presence of pooled human sera. Additionally, plasmid profile analysis and phage typing revealed no common strain causing the persistent bacteremia. The pathogenesis of persistent coagulase-negative staphylococcal bacteremia in low birth weight neonates without intravascular catheters remains obscure.

Sepsis and Mortality Prediction in Very Low Birth Weight Infants: Analysis of HeRO and nSOFA

2021 ◽  
Author(s):  
Angela C. Zeigler ◽  
John E. Ainsworth ◽  
Karen D. Fairchild ◽  
James L. Wynn ◽  
Brynne A. Sullivan
Keyword(s):  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Mortality Prediction ◽  
Blood Cultures ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Prediction Of Mortality

Objective Scores to predict sepsis or define sepsis severity could improve care for very low birth weight (VLBW) infants. The heart rate characteristics (HRC) index (HeRO score) was developed as an early warning system for late-onset sepsis (LOS), and also rises before necrotizing enterocolitis (NEC). The neonatal sequential organ failure assessment (nSOFA) was developed to predict sepsis-associated mortality using respiratory, hemodynamic, and hematologic data. The aim of this study was to analyze the HRC index and nSOFA near blood cultures in VLBW infants relative to diagnosis and sepsis-associated mortality. Study Design Retrospective, single-center study of VLBW infants from 2011 to 2019. We analyzed HRC index and nSOFA around blood cultures diagnosed as LOS/NEC. In a subgroup of the cohort, we analyzed HRC and nSOFA near the first sepsis-like illness (SLI) or sepsis ruled-out (SRO) compared with LOS/NEC. We compared scores by diagnosis and mortality during treatment. Results We analyzed 179 LOS/NEC, 93 SLI, and 96 SRO blood culture events. In LOS/NEC, the HRC index increased before the blood culture, while nSOFA increased at the time of culture. Both scores were higher in nonsurvivors compared with survivors and in LOS/NEC compared with SRO. The nSOFA 12 hours after the time of blood culture predicted mortality during treatment better than any other time point analyzed (area under the curve 0.91). Conclusion The HRC index provides earlier warning of imminent sepsis, whereas nSOFA after blood culture provides better prediction of mortality. Key Points

Fungal Infections in Premature Infants

PEDIATRICS ◽  
1984 ◽  
Vol 74 (3) ◽  
pp. 443-443
Author(s):  
DAVID R. LANGDON
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Fungal Infections ◽  
Clinical Manifestations ◽  
Low Birth Weight Infants ◽  
Central Lines ◽  
Increased Risk ◽  
Clinical Detail

To the Editor.— Baley et al, in "Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Etiology" (Pediatrics 1984;73:144-152), provided a wealth of clinical detail about systemic candidiasis in very low-birth-weight infants and emphasized the increased risk in infants with a prolonged period of parenteral alimentation via central lines. They observed late-onset carbohydrate intolerance in these infected infants and imply that fungal sepsis may precipitate hyperglycemia. The causal relationship and temporal sequence of such insidious conditions as hyperglycemia and candidemia may be difficult to establish in retrospect.

Benzyl Alcohol Toxicity: Impact on Neurologic Handicaps Among Surviving Very Low Birth Weight Infants

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 507-512 ◽  
Author(s):  
Gerda I. Benda ◽  
Janet L. Hiller ◽  
John W. Reynolds
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Benzyl Alcohol ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Alcohol Exposure ◽  
Dramatic Improvement ◽  
Low Birth Weight Infants ◽  
Intravascular Catheters

Benzyl alcohol perservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II). Survivors were enrolled in a follow-up program. Results of the study demonstrated that infants from period II had fewer neurologic handicaps. The incidence of cerebral palsy decreased from 50% to 2.4% (P < .001), and the presence of cerebral palsy and developmental delay combined decreased from 53.9% to 11.9% (P < .001). Several factors other than benzyl alcohol exposure were examined for their importance on outcome but were found not to be related to it. It is concluded that the dramatic improvement in outcome could be the result of discontinuation of benzyl alcohol.

Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Epidemiology

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 144-152
Author(s):  
Jill E. Baley ◽  
Robert M. Kliegman ◽  
Avroy A. Fanaroff
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Fungal Infection ◽  
Very Low Birth Weight ◽  
Fungal Infections ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Abdominal Distension ◽  
Acute Onset ◽  
Low Birth Weight Infants

In 1979 and 1980, an apparent increase in the occurrence of disseminated fungal infections was observed. The clinical features of such infections in very low-birth weight infants are poorly described, and diagnosis is often delayed. Over a 24-month period, a discrete group of ten clinically diagnosed and four autopsy-diagnosed cases of systemic fungal infections in very low-birth-weight infants was observed. Prior to developing systemic fungal illness, these infants required prolonged total parenteral nutrition, central arterial or venous catheters, and multiple courses of broad-spectrum antibiotics for documented or suspected bacterial sepsis. The clinically diagnosed disseminated fungal infection (ten infants) was noted at a mean age of 33 days with one or more of the following: respiratory deterioration, abdominal distension, guaiac positive stools, carbohydrate intolerance, candiduria, endophthalmitis, meningitis, abscesses, erythematous rash, temperature instability, and hypotension. These signs and symptoms were seen as chronic or were intermittent in clinical course. In contrast, the autopsy-diagnosed disseminated fungal infection (four infants) was present at an earlier age with fewer recognizable predisposing factors and a more acute onset of infection. Nevertheless, in both groups the diagnosis of systemic candidal infection was delayed, due to an inability to consistently recover the organism from blood, CSF, or urine. The neonatologist caring for the very low-birth-weight infant needs to become more aware of these clinical entities. A high index of suspicion and ancillary diagnostic evaluation, such as retinoscopy or tissue biopsy, may be indicated in the critically ill, culture-negative patient.

scholarly journals 387 Anemia and Elevated C-Reactive Protein in Premature Low Birth Weight Infants as Predictors of Positive Blood Cultures

2005 ◽  
Vol 58 (2) ◽  
pp. 420-420
Author(s):  
E J Van Der Gaag ◽  
E H Scholvinck ◽  
K A Bergman ◽  
PJJ Sauer ◽  
C V Hulzebos
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Blood Cultures ◽  
C Reactive Protein ◽  
Low Birth Weight Infants ◽  
Reactive Protein

scholarly journals Incidence and Clinical Manifestations of Breast Milk-Acquired Cytomegalovirus Infection in Low Birth Weight Infants

2005 ◽  
Vol 25 (5) ◽  
pp. 299-303 ◽  
Author(s):  
Dan Miron ◽  
Sharon Brosilow ◽  
Klari Felszer ◽  
Dan Reich ◽  
David Halle ◽  
...  
Keyword(s):  
Birth Weight ◽  
Breast Milk ◽  
Low Birth Weight ◽  
Cytomegalovirus Infection ◽  
Clinical Manifestations ◽  
Low Birth Weight Infants

Persistent coagulase-negative staphylococci bacteremia in very-low-birth-weight infants

2011 ◽  
Vol 170 (8) ◽  
pp. 989-995 ◽  
Author(s):  
Nehama Linder ◽  
Adriana Hernandez ◽  
Limor Amit ◽  
Gil Klinger ◽  
Shai Ashkenazi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Coagulase Negative Staphylococci ◽  
Low Birth Weight Infants
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