title: Coagulase-negative staphylococcal infections in the neonatal intensive care unit.
abstract: BACKGROUND
  Coagulase-negative staphylococci (CoNS) are the most commonly isolated pathogens in the neonatal intensive care unit (NICU). CoNS infections are associated with increased morbidity, including neurodevelopmental impairment.
  
  
  OBJECTIVE
  To describe the epidemiology of CoNS infections in the NICU. To determine mortality among infants with definite, probable, or possible CoNS infections.
  
  
  METHODS
  We performed a retrospective cohort study of all blood, urine, and cerebrospinal fluid cultures from samples obtained from infants aged <121 postnatal days.
  
  
  METHODS
  A total of 248 NICUs managed by the Pediatrix Medical Group from 1997 to 2009.
  
  
  RESULTS
  We identified 16,629 infants with 17,624 episodes of CoNS infection: 1,734 (10%) definite, 3,093 (17%) probable, and 12,797 (73%) possible infections. Infants with a lower gestational age and birth weight had a higher incidence of CoNS infection. When controlling for gestational age, birth weight, and 5-minute Apgar score, we found that infants with definite, probable, or possible CoNS infection had lower mortality (odds ratio [OR], 0.74 [95% confidence interval {CI}: 0.61, 0.89], 0.68 [95% CI, 0.59, 0.79], and 0.69 [95% CI, 0.63, 0.76], respectively) compared with infants who had negative culture results (P = .001). No significant difference in overall mortality was found in infants who had definite CoNS infection compared with those who had probable or possible CoNS infection (OR, 0.93 [95% CI, 0.75, 1.16] and 0.85 [95% CI, 0.70, 1.03], respectively).
  
  
  CONCLUSIONS
  CoNS infection was strongly related to lower gestational age and birth weight. Infants with clinical sepsis and culture-positive CoNS infection had lower mortality rates than infants with clinical sepsis and negative blood culture results. No difference in mortality between infants with a diagnosis of definite, probable, or possible CoNS infection was observed.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Jean-Baptiste
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Matthew
authors.initials: M
authors.lastname: Laughon
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D001724:Birth Weight; D003030:Coagulase; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013210:Staphylococcus / Q000302:isolation & purification*
chemical_list: D003030:Coagulase