title: Fulminant late-onset sepsis in a neonatal intensive care unit, 1988-1997, and the impact of avoiding empiric vancomycin therapy.
abstract: OBJECTIVE
  To determine the pathogens associated with fulminant (lethal within 48 hours) late-onset sepsis (occurring after 3 days of age) in a neonatal intensive care unit (NICU) and the frequency of fulminant late-onset sepsis for the most common pathogens.
  
  
  METHODS
  A retrospective study was conducted of sepsis in infants in a NICU over a 10-year period (1988-1997).
  
  
  RESULTS
  There were 825 episodes of late-onset sepsis occurring in 536 infants. Thirty-four of 49 (69%; 95% confidence interval [CI]: 55%-82%) cases of fulminant late-onset sepsis were caused by Gram-negative organisms, including Pseudomonas sp., 20 (42%); Escherichia coli, 5 (10%); Enterobacter sp., 4 (8%); and Klebsiella sp., 4 (8%). The frequency of fulminant sepsis was highest for Pseudomonas sp., 20 of 36 (56%; 95% CI: 38%-72%) and lowest for coagulase-negative staphylococci, 4 of 277 (1%; 95%CI: 0%-4%). The very low frequency of fulminant sepsis caused by coagulase-negative staphylococci did not increase during the period when oxacillin was used instead of vancomycin as the empiric antibiotic for Gram-positive organisms.
  
  
  CONCLUSIONS
  These data suggest that empiric antibiotics selected for treatment of suspected sepsis in infants >3 days old need to effectively treat Gram-negative pathogens, particularly Pseudomonas sp., because these organisms, although less frequent, are strongly associated with fulminant late-onset sepsis in the NICU. Avoiding empiric vancomycin therapy seemed to be a reasonable approach to late-onset sepsis, because of the very low frequency of fulminant sepsis caused by coagulase-negative staphylococci.
authors: Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA.
authors: M G
authors: MG
authors: Karlowicz
authors: E S
authors: ES
authors: Buescher
authors: A E
authors: AE
authors: Surka
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology; D001424:Bacterial Infections / Q000145:classification* / Q000188:drug therapy* / Q000453:epidemiology; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008581:Meningitis / Q000453:epidemiology; D009657:North Carolina; D010068:Oxacillin / Q000627:therapeutic use; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D014640:Vancomycin / Q000008:administration & dosage*; D014768:Virginia
chemical_list: D014640:Vancomycin; D010068:Oxacillin