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  Vol. 258 No. 18, November 13, 1987 TABLE OF CONTENTS
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Coagulase-Negative Staphylococcal Bacteremia in the Changing Neonatal Intensive Care Unit Population

Is There an Epidemic?

Jonathan Freeman, MD, ScD; Richard Platt, MD, MS; David G. Sidebottom, MD; Jeanne M. Leclair, MPH; Michael F. Epstein, MD; Donald A. Goldmann, MD

JAMA. 1987;258(18):2548-2552.


Abstract

A fivefold increase in the number of cases of nosocomial coagulase-negative staphylococcal bacteremia was investigated in a neonatal intensive care unit between 1975 and 1982. This apparent outbreak was not the result of increased isolation of coagulase-negative staphylococci from blood cultures nor an increased frequency with which blood cultures were obtained. Rather, it was attributable to a dramatic increase in the overall probability that a positive blood culture would be interpreted as "bacteremia" as opposed to a contaminant by both physicians and infection control staff. Specifically, there had been a 62.3% increase in neonatal intensive care unit bed use by very-low-birth-weight (<1000-g) infants between 1975 and 1982, and in both years, positive blood cultures were 3.8 times as likely to be perceived as clinically significant if obtained from such tiny infants. The growing number of very-low-birth-weight babies occupying neonatal intensive care unit beds, coupled with the observation that blood cultures positive for coagulase-negative staphylococci are almost four times as likely to be perceived as clinically significant if obtained from extremely premature infants, may account for the reported increase in nosocomial coagulase-negative staphylococcal bacteremia.

(JAMA 1987;258:2548-2552)



Author Affiliations

From the Channing Laboratory, Brigham and Women's Hospital (Drs Freeman and Platt), the Brockton/West Roxbury Veterans Administration Hospital (Dr Freeman), and the Division of Infectious Diseases (Drs Sidebottom and Goldmann), the Infection Control Program (Drs Goldmann and Ms Leclair), and the Division of Newborn Medicine (Dr Epstein), Children's Hospital, Harvard Medical School, Boston.


Footnotes

Presented in part at a meeting of the Society for Pediatric Research, Washington, DC, May 6, 1986.

Reprint requests to Channing Laboratory, 180 Longwood Ave, Boston, MA 02115 (Dr Freeman).



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