title: Clinical and molecular epidemiologic characteristics of coagulase-negative staphylococcal bloodstream infections in intensive care neonates.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatrics, Erasmus MC--Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Vishal
authors.initials: V
authors.lastname: Hira
authors.forename: Marcel
authors.initials: M
authors.lastname: Sluijter
authors.forename: Silvia
authors.initials: S
authors.lastname: Estevão
authors.forename: Deborah
authors.initials: D
authors.lastname: Horst-Kreft
authors.forename: Alewijn
authors.initials: A
authors.lastname: Ott
authors.forename: Ronald
authors.initials: R
authors.lastname: de Groot
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
authors.forename: René F
authors.initials: RF
authors.lastname: Kornelisse
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D017720:Molecular Epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification / Q000201:enzymology / Q000235:genetics*