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The Role of Coagulase-negative Staphylococci in Early Onset Sepsis in a Large European Cohort of Very Low Birth Weight Infants

Mularoni, Alessandra MD*; Madrid, Marisela BSB; Azpeitia, Agueda BS; Valls i Soler, Adolf MD, PhD

The Pediatric Infectious Disease Journal: May 2014 - Volume 33 - Issue 5 - p e121–e125
doi: 10.1097/INF.0000000000000175
Original Studies

Background: Early Onset Sepsis (EOS) is associated with increased major morbidity and mortality rates among very low birth weight (VLBW) infants. The epidemiology is changing in response to evolving medical practice. The objective of the study was to evaluate EOS epidemiology, risk factors, mortality and major morbidity rates among VLBW infants within a European cohort.

Methods: Data from VLBW infants born from 2006 through 2009 was collected by neonatal units participating in the EuroNeoNet initiative. Univariate and multivariate analyses were performed to assess the independent association of EOS with VLBW infant’s perinatal characteristics, morbidity and mortality rates.

Results: The cohort included 14,719 infants, 391 developed EOS (2.7%). The most common pathogen responsible for EOS was Gram-positive bacteria (53.9%). Coagulase-negative staphylococci (CoNS) were isolated in 22.5% of episodes. Antenatal steroids exposure, single gestation, very low gestational age and birth weight, low 5 minute Apgar score and delivery room resuscitation were independently associated with EOS. EOS was also associated with a longer hospital stay, increased risk of mortality [adjusted odd ratio (aOR): 2.4; 95% Confidence Interval (CI): 1.9–3.1], respiratory distress syndrome (OR: 1.4; 95% CI: 1.1–1.9), severe intraventricular haemorrhage (aOR: 2.1; 95%CI: 1.6–2.8) and severe retinopathy of prematurity (aOR: 5; 95% CI: 1.9–13.3). Morbidity and mortality rates of infants with EOS caused by CoNS were similar to those of infants with EOS caused by other pathogens.

Conclusions: VLBW infants with EOS are at an increased risk of mortality and major morbidities. CoNS was a significant cause of sepsis, infants with CoNS were at a similarly high risk of complication of prematurity and mortality as those with EOS caused by other organisms.

From the *Pediatric Infectious Disease, Istituto Giannina Gaslini, largo Gerolamo Gaslini, Genova, Italy; and Neonatal Epidemiological Unit, Hospital de Cruces, Barakaldo-Bilbao, Spain.

Accepted for publication October 18, 2013.

This study was supported by grants from the Directorate-General for Health and Consumers (DGSANCO) to Adolfo Valls Soler (EuroNeoStat I and II) and Alessandra Mularoni who received a grant from the Italian Society of Tropical and Infectious Diseases (SIMIT). The authors have no funding or conflicts of interest relevant to this article to disclose.

Address for correspondence: Alessandra Mularoni, MD, ISMETT-UPMC via Tricomi, 1 90133 Palermo. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.