508 COAGULASE-NEGATIVE STAPHYLOCOCCUS (CNS) BACTEREMIA - OBSERVATIONS ON MORTALITY AND MORBIDITY

Abstract

Bacteremia with coagulase-negative staphylococcus often presents as an indolent disease; blood cultures positive for CNS are frequently regarded as “contaminated.” We analyzed the records of 42 infants born at the Hosp. of the Univ. of PA. from 1/82 - 9/94 diagnosed with CNS bacteremia to determine the mortality and morbidity associated with this organism. Mean birth weight and gestational age of the infants were, 1017 g (range, 350 - 2680 g) and 28.2 wks (range, 25 - 38 wks), respectively. Thirty of 42 infants (71%) weighed ≤ 1250g. Supportive measures at the time of CNS bacteremia (numbers are mean and range) included: Hyperalimentation, 28/42 (67%) infants for 26 days (7-60 days), mechanical ventilation, 24/42 (59%) infants for 41 days (1-150 days), central venous catheter, 10/42 (24%) infants for 16 days (1-60 days). Focal infection with CNS in the bacteremic infants included: meningitis, 3 infants (7%), pneumonia, 7 infants (16%), and urinary tract infetion, 1 infant (2%). Twelve infants (29%) developed grossly bloody stools and abdominal distension at the time of diagnosis of CNS bacteremia. No infant with coagulase-negative bacteremia expired as a direct result of sepsis with this organism. However, 91% of CNS were resistant to gentamicin, necessitating a change in antibiotics to vancomycin.

This study indicates that although bacteremia with CNS primarily affects the low birth weight critically ill newborn, and has a universally favorable prognosis with respsect to mortality, significant morbidity exists. The emergence of gentamicin-resistant CNS is of great concern and may alter this favorable prognosis.

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