Khashu Minesh, Osiovich Horacio, Henry Deborah, Al Khotani Aziz, Solimano Alfonso, Speert David P
Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Pediatrics. 2006 Feb;117(2):340-8. doi: 10.1542/peds.2005-0333.
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.
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.
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.
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.
凝固酶阴性葡萄球菌（CoNS）是新生儿重症监护病房（NICU）晚发性败血症最常见的病因，但死亡率罕见，发病率也不常见。我们报告了一种新的CoNS败血症综合征，其特征是尽管进行了积极的抗生素治疗且未发现感染灶，但仍有显著的发病率和持续性菌血症。
我们对2000年至2002年间NICU中患有CoNS菌血症的婴儿进行了回顾性研究。统计分析包括初步探索性分析，随后进行逻辑回归分析。对所有分离株进行微生物鉴定和分子分型。
将31例持续性CoNS菌血症的新生儿与从140例非持续性CoNS菌血症患儿中随机选取的60例新生儿进行比较。两组患儿就诊时的临床表现、胎龄和出生体重相似。26例（84%）持续性CoNS菌血症新生儿出现血小板减少，而非持续性组仅有8例（13%）出现血小板减少。中心静脉置管增加了持续性CoNS菌血症的风险，但持续性组中有42%从未进行过置管。表皮葡萄球菌是两组中最常见的分离株。分子分型未能鉴定出优势克隆。
持续性CoNS败血症综合征的显著特点是血小板减少且在无中心静脉置管的情况下持续存在。就诊时的临床表现和人口统计学特征在持续性和非持续性组之间并无差异。我们未发现特别毒力克隆的出现，但有可能某些CoNS菌株已获得在不同条件下持续存在的能力。
