Schmidt B K, Kirpalani H M, Corey M, Low D E, Philip A G, Ford-Jones E L
Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Infect Dis J. 1987 Nov;6(11):1026-31.
We examined the pathogenicity of coagulase-negative staphylococci (CONS) in newborn infants by comparing presenting nonspecific signs of infection in infants with and without CONS bacteremia. During a 6-month period 799 blood cultures were obtained in a tertiary care nursery; 81 (10.1%) grew CONS and 25 (3.0%) grew other bacteria. A comparison group of 121 infants was selected randomly from ill patients whose blood cultures were negative. In addition 70 well infants were matched to CONS-positive cases. Abnormal clinical signs, complete blood cell counts, C-reactive protein, alpha-1-acid glycoprotein and prealbumin were determined at the time of culture. Signs that discriminated best between infants with and without CONS bacteremia were identified by logistic regression analysis. Infants with CONS bacteremia did not differ from infants with sepsis caused by recognized pathogens, except for lethargy, which was significantly more common in unequivocal infection. Infants with presumed infection but negative blood cultures, and noninfected control patients had abnormal signs significantly less often than CONS-positive infants. C-reactive protein, hyperthermia, increased oxygen requirements and lethargy were the most useful signs in identifying neonatal bloodstream infection. This cohort study provides objective evidence for the pathogenicity of CONS in newborn infants.
我们通过比较有和没有凝固酶阴性葡萄球菌（CONS）菌血症的婴儿出现的非特异性感染体征，研究了CONS在新生儿中的致病性。在一个三级护理托儿所的6个月期间，共采集了799份血培养样本；其中81份（10.1%）培养出CONS，25份（3.0%）培养出其他细菌。从血培养阴性的患病婴儿中随机选取121名婴儿作为对照组。此外，将70名健康婴儿与CONS阳性病例进行匹配。在培养时测定异常临床体征、全血细胞计数、C反应蛋白、α-1-酸性糖蛋白和前白蛋白。通过逻辑回归分析确定了在有和没有CONS菌血症的婴儿之间鉴别效果最佳的体征。除了嗜睡在明确感染中明显更常见外，CONS菌血症婴儿与由公认病原体引起的败血症婴儿没有差异。推测感染但血培养阴性的婴儿以及未感染的对照患者出现异常体征的频率明显低于CONS阳性婴儿。C反应蛋白、体温过高、需氧量增加和嗜睡是识别新生儿血流感染最有用的体征。这项队列研究为CONS在新生儿中的致病性提供了客观证据。
