This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (61)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Late-Onset Septicemia in a Norwegian National Cohort of Extremely Premature Infants Receiving Very Early Full Human Milk Feeding
Ronnestad et al.
Pediatrics 2005;115:e269-e276.
ABSTRACT | FULL TEXT  

Prevalence of methicillin-resistant, coagulase-negative staphylococci in neonatal intensive care units: findings from a tertiary care hospital in India
Jain et al.
J Med Microbiol 2004;53:941-944.
ABSTRACT | FULL TEXT  

Nosocomial Bloodstream Infections: Secular Trends in Rates, Mortality, and Contribution to Total Hospital Deaths
Pittet and Wenzel
Arch Intern Med 1995;155:1177-1184.
ABSTRACT  

Extra Hospital Stay and Antibiotic Usage With Nosocomial Coagulase-Negative Staphylococcal Bacteremia in Two Neonatal Intensive Care Unit Populations
Freeman et al.
Arch Pediatr Adolesc Med 1990;144:324-329.
ABSTRACT  

Epidemic Methicillin-Gentamicin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit
Reboli et al.
Arch Pediatr Adolesc Med 1989;143:34-39.
ABSTRACT