Seale Anna C, Obiero Christina W, Jones Kelsey D, Barsosio Hellen C, Thitiri Johnstone, Ngari Moses, Morpeth Susan, Mohammed Shebe, Fegan Gregory, Mturi Neema, Berkley James A
From the *Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Institution, Kilifi, Kenya; †University of Oxford, Oxford, United Kingdom; and ‡London School of Hygiene and Tropical Medicine, and §Imperial College London, London, United Kingdom.
Pediatr Infect Dis J. 2017 Nov;36(11):1073-1078. doi: 10.1097/INF.0000000000001699.
Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. While coagulase-negative staphylococci (CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need for early anti-Staphylococcal treatment in empiric antibiotic guidelines, is unknown in sub-Saharan Africa.
We examined systematic clinical and microbiologic surveillance data from all neonatal admissions to Kilifi County Hospital (1998-2013) to determine associated case fatality and/or prolonged duration of admission associated with CoNS in neonates treated according to standard World Health Organization guidelines.
CoNS was isolated from blood culture in 995 of 9552 (10%) neonates. Case fatality among neonates with CoNS isolated from blood did not differ from other neonatal admissions (P = 0.2), and duration of admission was not prolonged [odds ratio (OR) = 0.9 (0.7-1.0), P = 0.040]. Neonates with CoNS were more likely to have convulsions [OR = 1.4 (1.0-1.8), P = 0.031] but less likely to have impaired consciousness or severe indrawing [OR = 0.8 (0.7-0.9), P = 0.025; OR = 0.9 (0.7-1.0), P = 0.065].
CoNS isolation in blood cultures at admission was not associated with adverse clinical outcomes in neonates treated according to standard World Health Organization guidelines for hospital care in this setting. There is no evidence that first-line antimicrobial treatment guidelines should be altered to increase cover for CoNS infections in neonates in this setting.
撒哈拉以南非洲地区的新生儿死亡率仍然很高，估计有三分之一的死亡是由感染导致的。虽然凝固酶阴性葡萄球菌（CoNS）在资源丰富地区是主要的新生儿病原体，但在撒哈拉以南非洲地区，它们的作用以及在经验性抗生素指南中进行早期抗葡萄球菌治疗的必要性尚不清楚。
我们检查了基利菲县医院（1998 - 2013年）所有新生儿入院的系统临床和微生物监测数据，以确定根据世界卫生组织标准指南治疗的新生儿中，与CoNS相关的病例死亡率和/或住院时间延长情况。
在9552例新生儿中，有995例（10%）血培养分离出CoNS。血培养分离出CoNS的新生儿的病例死亡率与其他新生儿入院情况无差异（P = 0.2），住院时间也未延长[比值比（OR）= 0.9（0.7 - 1.0），P = 0.040]。CoNS感染的新生儿更易发生惊厥[OR = 1.4（1.0 - 1.8），P = 0.031]，但意识障碍或重度吸气凹陷的可能性较小[OR = 0.8（0.7 - 0.9），P = 0.025；OR = 0.9（0.7 - 1.0），P = 0.065]。
在这种情况下，根据世界卫生组织医院护理标准指南治疗的新生儿，入院时血培养分离出CoNS与不良临床结局无关。没有证据表明应改变一线抗菌治疗指南以增加对该地区新生儿CoNS感染的覆盖。
