title: The role of coagulase-negative staphylococci in early onset sepsis in a large European cohort of very low birth weight infants.
abstract: 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.
authors.affiliation: From the *Pediatric Infectious Disease, Istituto Giannina Gaslini, largo Gerolamo Gaslini, Genova, Italy; and †Neonatal Epidemiological Unit, Hospital de Cruces, Barakaldo-Bilbao, Spain.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mularoni
authors.forename: Marisela
authors.initials: M
authors.lastname: Madrid
authors.forename: Agueda
authors.initials: A
authors.lastname: Azpeitia
authors.forename: Adolf
authors.initials: A
authors.lastname: Valls i Soler
mesh_terms: D003030:Coagulase / Q000172:deficiency*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D019102:Infant, Very Low Birth Weight; D008297:Male; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification / Q000201:enzymology / Q000302:isolation & purification*; D016019:Survival Analysis
chemical_list: D003030:Coagulase