Staphylococcal Infection in the Neonatal Intensive Care Unit

ABSTRACT

PURPOSE: Staphylococcal bacteremia is a major problem in the neonatal intensive care unit. But, there is little data on staphylococcal bacteremia in the neonatal intensive care unit in Korea. We searched for patterns of staphylococcal infection in neonatal intensive care units. METHODS: A retrospective study was conducted on infants who had staphylococcal bacteremia and were in the neonatal intensive care unit between 2001, February and 2007, May. RESULTS: A total of 48 cases were reviewed (mean gestational age 31 wks [23-40], mean birth weight 1689 g [510-3,920]). The vast majority of cases were coagulase-negative staphylococcus (CoNS) (30 cases, 62.5%). Staphylococcus aureus caused 36.1% of staphylococcal bacteremia (17 cases). Methicillin-resistant staphylococcal aureus (MRSA) (14 cases) caused 77.7% of staphylococcal aureus bacteremia. Peripherally inserted central venous catheters were placed in situ in most patients (MSSA 75%, MRSA 88.2%, CoNS 62.1%). Most of the staphylococcal bacteremia in patients were hospital-acquired (81%). Fifteen cases increased levels of C-reactive protein (CRP) (31%). (Mean CRP MSSA 1.07 mg/dL, MRSA 3.64 mg/dL, CoNS 0.54 mg/dL). Exclusively MRSA had focal complications (osteomyelitis/arthritis 3 cases). Vancomycin was used in 47.4% in MRSA and 52.6% in CoNS. Four patients (8.3%) died, but all were not directly attributable. CONCLUSION: The staphylococcal bacteremia was generally observed to be a hospital- acquired infection in the neonatal intensive care unit. MRSA caused more elevation of CRP levels and focal complication. To know exactly that what the pattern of staphylococcal bacteremia in Korea is, more research is needed in other neonatal intensive care unit.