Daniel O'Reilly1, Ciara O'Connor2, Naomi McCallion3,4, Richard J Drew5,6,7. 1. Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland. danieloreilly@rcsi.com. 2. Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland. 3. Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland. 4. Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin 2, Ireland. 5. Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland. 6. Department of Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland. 7. Irish Meningitis and Sepsis Reference Laboratory (IMSRL), Temple Street Children's University Hospital, Dublin 1, Ireland.
Abstract
BACKGROUND: Staphylococcus aureus bacteraemia (SAB) in NICU patients can cause significant morbidity and mortality. AIMS: To review early and late neonatal SAB with regard to risk factors, treatment, acute complications and long-term outcomes. METHODS: A retrospective study of laboratory confirmed SAB over a 16-year period (November 2001-January 2017) in a tertiary neonatal unit in Ireland. FINDINGS: A total of 74 neonates (MSSA n = 72, MRSA n = 2) were identified; 8.1% (n = 6) early sepsis, 91.8% (n = 68) late sepsis. Low birth weight neonates (born weighing less than 2500 g) 80% (n = 59). Median age to bacteraemia 11 days post-delivery (range = 0-100 days); median onset early sepsis 1.5 days versus late sepsis 12 days. Complications of SAB; cellulitis n = 17, pneumonia n = 12, necrotising enterocolitis n = 7, thromobophlebitis n = 5, skin abscess formation n = 4, osteomyelitis n = 3, endocarditis n = 1. Late SAB mortality 6.4% (n = 3). CONCLUSIONS: Preterm and low birth weight infants were at highest risk of SAB. Only a small proportion of affected children had long-term clinical sequelae on follow-up. The high rate of recurrence and breakthrough bacteraemia suggests that early implementation of a targeted anti-staphylococcal antimicrobial regimen may be of particular benefit.
BACKGROUND:Staphylococcus aureus bacteraemia (SAB) in NICU patients can cause significant morbidity and mortality. AIMS: To review early and late neonatal SAB with regard to risk factors, treatment, acute complications and long-term outcomes. METHODS: A retrospective study of laboratory confirmed SAB over a 16-year period (November 2001-January 2017) in a tertiary neonatal unit in Ireland. FINDINGS: A total of 74 neonates (MSSA n = 72, MRSA n = 2) were identified; 8.1% (n = 6) early sepsis, 91.8% (n = 68) late sepsis. Low birth weight neonates (born weighing less than 2500 g) 80% (n = 59). Median age to bacteraemia 11 days post-delivery (range = 0-100 days); median onset early sepsis 1.5 days versus late sepsis 12 days. Complications of SAB; cellulitis n = 17, pneumonia n = 12, necrotising enterocolitis n = 7, thromobophlebitis n = 5, skin abscess formation n = 4, osteomyelitis n = 3, endocarditis n = 1. Late SAB mortality 6.4% (n = 3). CONCLUSIONS: Preterm and low birth weight infants were at highest risk of SAB. Only a small proportion of affected children had long-term clinical sequelae on follow-up. The high rate of recurrence and breakthrough bacteraemia suggests that early implementation of a targeted anti-staphylococcal antimicrobial regimen may be of particular benefit.
Entities:
Keywords:
Neonatal intensive care unit; Outcomes; Staphylococcus aureus bloodstream infection
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