title: Risk factors for persistent bacteremia in infants with catheter-related bloodstream infection due to coagulase-negative Staphylococcus in the neonatal intensive care unit.
abstract: BACKGROUND
  Coagulase-negative Staphylococcus (CoNS) is the predominant cause of catheter-related bloodstream infections (CRBSI). Infants in neonatal intensive care units (NICU) often suffer from CoNS CRBSI, which are often refractory to treatment.
  
  
  OBJECTIVE
  We sought to evaluate risk factors for developing persistent bacteremia due to CoNS CRBSI in infants, in order to identify those who require early aggressive management.
  
  
  METHODS
  We conducted a retrospective case-control study of infants in the NICU who developed CRBSI due to CoNS. Patient demographics, condition and management of CRBSI were compared between those with persistent and non-persistent bacteremia. Furthermore, prognosis of infants in the NICU after CoNS CRBSI was evaluated.
  
  
  RESULTS
  Seventy six episodes of CRBSI, including 17 persistent bacteremia and 59 non-persistent bacteremia, were analyzed. In univariate analyses, persistent bacteremia was significantly associated with corrected age equivalent to gestational age of 22-28 weeks at onset of CRBSI [Odds ratio (OR) = 4.33; P = 0.04], platelet count <100,000/μL (OR = 11.5; P < 0.001), use of vasopressor (OR = 5.38; P = 0.003), and delayed CVC removal (OR = 6.25; P = 0.003). In multivariate analysis, persistent bacteremia was significantly associated with platelet count <100,000/μL (OR = 7.80; P = 0.007), and delayed CVC removal (OR = 5.07; P = 0.03). Infants with persistent bacteremia tended to have a lower survival rate after CoNS CRBSI, however this was not statistically significant (P = 0.21).
  
  
  CONCLUSIONS
  Early CVC removal should be considered for the treatment of CRBSI due to CoNS in infants with platelet counts of less than 100,000/μL.
authors.affiliation: Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. Electronic address: furuichi-mn@ncchd.go.jp.
authors.forename: Munehiro
authors.initials: M
authors.lastname: Furuichi
authors.affiliation: Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Miyairi
mesh_terms: D016470:Bacteremia / Q000209:etiology*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003030:Coagulase / Q000378:metabolism*; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology*; D013210:Staphylococcus / Q000378:metabolism*
chemical_list: D003030:Coagulase
keywords: Catheter-related bloodstream infection; Coagulase-negative Staphylococcus; Neonatal intensive care unit; Persistent bacteremia; Thrombocytopenia