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Clinical and Molecular Epidemiologic Characteristics of Coagulase-Negative Staphylococcal Bloodstream Infections in Intensive Care Neonates

Hira, Vishal MSc*; Sluijter, Marcel BSc*; Estevão, Silvia BSc*; Horst-Kreft, Deborah BSc; Ott, Alewijn PhD; de Groot, Ronald PhD; Hermans, Peter W. M. PhD; Kornelisse, René F. PhD*

The Pediatric Infectious Disease Journal: July 2007 - Volume 26 - Issue 7 - p 607-612
doi: 10.1097/INF.0b013e318060cc03
Original Studies

Objectives: This study aimed to determine clinical characteristics of coagulase-negative staphylococcal (CoNS) sepsis in neonates, to assess the molecular epidemiology and biofilm forming properties of isolated strains, and to assess antibiotic susceptibility of clonal compared with incidentally occurring strains.

Methods: We performed a retrospective study on late-onset CoNS sepsis in infants in the neonatal intensive care unit of a Dutch university hospital in 2003. CoNS isolates were genotyped by restriction fragment end labeling and pulsed-field gel electrophoresis. Resistance profiles, biofilm production, and the presence of mecA and icaA were determined.

Results: Twenty-six percent of all 339 infants developed late-onset sepsis, 66% of these with CoNS sepsis. Eighty-six percent of all CoNS sepsis occurred in very low birth weight infants. Sixty-six CoNS strains were isolated. In multivariate analysis, small for gestational age and prolonged hospitalization were associated with CoNS sepsis. Among 3 restriction fragment end labeling clusters, we found 1 large cluster comprising 32% of the isolates. Biofilm producing Staphylococcus epidermidis were more frequently icaA positive than nonbiofilm formers (74% vs. 12%; P < 0.001). In other species, this association was not found. Nearly all isolates were resistant to antibiotics. MecA was present in 87% of the isolates. Multiresistance occurred in 77% of all strains and in 73% of clustered strains. There was significantly less multiresistance among the largest cluster.

Conclusions: Small for gestational age and prolonged hospitalization were associated with CoNS sepsis. The icaA gene is a predictor for biofilm formation in S. epidermidis, but not in other species. Multiresistance is not associated with clonality.

Supplemental Digital Content is Available in the Text.

From the Departments of *Pediatrics and †Medical Microbiology and Infectious Diseases, Erasmus MC–Sophia Children's Hospital, Rotterdam, The Netherlands; and ‡Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Accepted for publication March 21, 2007.

Address for correspondence: R. F. Kornelisse, MD, PhD, Department of Pediatrics, Division of Neonatology, Erasmus MC–Sophia Children's Hospital, PO BOX 2060, Room Sp-3429, 3000 CB Rotterdam, The Netherlands. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.