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Extra Hospital Stay and Antibiotic Usage With Nosocomial Coagulase-Negative Staphylococcal Bacteremia in Two Neonatal Intensive Care Unit Populations
Jonathan Freeman, MD, ScD;
Michael F. Epstein, MD;
Nancy E. Smith, MS;
Richard Platt, MD, MS;
David G. Sidebottom, MD;
Donald A. Goldmann, MD
Am J Dis Child. 1990;144(3):324-329.
Abstract
• Coagulase-negative staphylococci were the leading cause of nosocomial bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and Children's Hospital, Boston, Mass, in 1982. To determine the consequences of these nosocomial bacteremias, a cohort study was conducted in which two comparison subjects were matched with each of 38 bacteremic infants by hospital, birth weight within 100 g, and nearest date of discharge. To adjust for duration of stay in the hospital, it was also required that both comparison subjects have survived and remained in the hospital for as long as the time until bacteremia occurred in the bacteremic infant. The average day of onset of bacteremia was the 20th hospital day. Despite having similar birth weights and comparable severity of underlying illness, bacteremic infants remained in the hospital for an average of 19.8 days longer than the nonbacteremic comparison subjects (77.3 vs 57.5 days). The bacteremic patients received antibiotics for an average of 11.2 more days than the nonbacteremic infants. Vancomycin hydrochloride was given to 20 (52.6%) of the bacteremic patients but only 4 (5.3%) of the comparison patients. All of the comparison subjects and 37 of the 38 infants with bacteremia survived. Thus, nosocomial bacteremia with coagulase-negative staphylococci is a late complication of hospitalization that occurs in infants who are already relatively long-term survivors. This bacteremia appears to be associated with substantially longer hospital stay and antibiotic therapy but little, if any, excess mortality.
(AJDC. 1990;144:324-329)
Author Affiliations
From the Channing Laboratory (Drs Freeman and Platt), the Department of Medicine (Drs Freeman and Platt), and the Division of Newborn Medicine (Dr Epstein), Brigham and Women's Hospital, Brockton/West Roxbury Veterans Administration Medical Center (Drs Freeman and Smith), and the Divisions of Newborn Medicine (Dr Epstein) and Infectious Diseases (Drs Sidebottom and Goldmann) and the Infection Control Program (Drs Sidebottom and Goldmann), Children's Hospital. Harvard Medical School, and the Department of Epidemiology, Harvard School of Public Health (Dr Freeman), Boston, Mass. Dr Platt is a Burroughs-Wellcome Scholar in Pharmacoepidemiology.
Footnotes
Accepted for publication September 18, 1989.
Presented in part at a joint meeting of the American Pediatric Society and the Society for Pediatric Research, Washington, DC, May 6, 1986.
Reprint requests to West Roxbury VA Hospital, HSR&D 152, 1400 Veterans of Foreign Wars Parkway, West Roxbury, MA 02132 (Dr Freeman).
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