Staphylococcus capitis Induced Late-onset Sepsis in Very Low Birth Weight Infants

In Kim; Gina Lim; Eun Ha Hwang; Ki Won Oh; Joseph Jeong

doi:10.14734/PN.2017.28.04.140

Journal List > Perinatology > v.28(4) > 1071352

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lim, Hwang, Oh, and Jeong: Staphylococcus capitis Induced Late-onset Sepsis in Very Low Birth Weight Infants

Original Article

Perinatology 2017;28(4):140-145.

Published online: 19 January 2017

DOI: https://doi.org/10.14734/PN.2017.28.04.140

Staphylococcus capitis Induced Late-onset Sepsis in Very Low Birth Weight Infants

In Kim, MD¹, Gina Lim, MD¹, Eun Ha Hwang, MD¹, Ki Won Oh, MD¹, Joseph Jeong, MD²

¹Departments of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

²Departments of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Correspondence to Ki Won Oh, MD Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea Tel: +82-52-250-8861 Fax: +82-52-250-8071 E-mail: : pentawish@hanmail.net

Received 24 July 2017 Revised 22 September 2017 Accepted 27 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To determine the causative organisms of late-onset sepsis (LOS) and describe LOS induced by Staphylococcus capitis (S. capitis) in very low birth weight infants (VLBWI).

Methods

The medical records of VLBWI with blood culture proven LOS admitted to Ulsan University Hospital between January 2010 and December 2016 were investigated retrospectively.

Results

Among 329 VLBWI, 84 episodes of LOS occurred in 60 neonates (18.2%). Forty-two (50.0%) episodes were caused by coagulase-negative staphylococci (CoNS) and S. capitis and S. epidermidis were the leading organisms. S. capitis LOS developed in 21 VLBWI with 26 (30.9%) episodes. Necrotizing enterocolitis developed in 3 patients and 1 was diagnosed with infectious endocarditis. Six neonates died and death in 2 patients was directly related to S. capitis LOS. All episodes of S. capitis LOS demonstrated oxacillin and multi-drug resistance.

Conclusion

CoNS are the most common cause of LOS in VLBWI. In addition to S. epidermidis, S. capitis should be considered as an important emerging cause of LOS, as it is associated with severe morbidity and increased mortality in VLBWI.

Keywords: Staphylococcus capitis, Neonatal sepsis, Very-low-birth-weight infant

REFERENCES

1). Stoll BJ., Hansen N., Fanaroff AA., Wright LL., Carlo WA., Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002. 110(2 Pt 1):285–91.

2). Lee SM., Chang M., Kim KS. Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in Korea. J Korean Med Sci. 2015. 30(Suppl 1):S67–74.

3). Boghossian NS., Page GP., Bell EF., Stoll BJ., Murray JC., Cotton CM, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr. 2013. 162:1120–4.

4). Klingenberg C., Rønnestad A., Anderson AS., Abrahamsen TG., Zorman J., Villaruz A, et al. Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit: virulence factors and invasiveness. Clin Microbiol Infect. 2007. 13:1100–11.

5). Ruhe J., Menon A., Mushatt D., Dejace P., Hasbun R. Non-epidermidis coagulase-negative staphylococcal bacteremia: clinical predictors of true bacteremia. Eur J Clin Microbiol Infect Dis. 2004. 23:495–8.

6). Park HW., Lim G., Koo SE., Lee BS., Kim KS., Pi SY, et al. Causative agents and antimicrobial sensitivity of neonatal sepsis: ten-year experience in one neonatal intensive care unit. J Korean Soc Neonatol. 2009. 16:172–81.

7). Wang SM., Liu CC., Tseng HW., Yang YJ., Lin CH., Huang AH, et al. Staphylococcus capitis bacteremia of very low birth weight premature infants at neonatal intensive care units: clinical significance and antimicrobial susceptibility. J Microbiol Immunol Infect. 1999. 32:26–32.

8). Gras-Le Guen C., Fournier S., Andre-Richet B., Caillon J., Chamoux C., Espaze E, et al. Almond oil implicated in a Staphylococcus capitis outbreak in a neonatal intensive care unit. J Perinatol. 2007. 27:713–7.

9). Rasigade JP., Raulin O., Picaud JC., Tellini C., Bes M., Grando J, et al. Methicillin-resistant Staphylococcus capitis with reduced vancomycin susceptibility causes late-onset sepsis in intensive care neonates. PLoS One. 2012. 7:e31548.

10). Ben Said M., Hays S., Bonfils M., Jourdes E., Rasigade JP., Laurent F, et al. Late-onset sepsis due to Staphylococcus capitis tneonatalis' in low-birthweight infants: a new entity? J Hosp Infect. 2016. 94:95–8.

11). Van Der Zwet WC., Debets-Ossenkopp YJ., Reinders E., Kapi M., Savelkoul PH., Van Elburg RM, et al. Nosocomial spread of a Staphylococcus capitis strain with heteroresistance to vancomycin in a neonatal intensive care unit. J Clin Microbiol. 2002. 40:2520–5.

12). Butin M., Rasigade JP., Martins-Simões P., Meugnier H., Lemriss H., Goering RV, et al. Wide geographical dissemination of the multiresistant Staphylococcus capitis NRCS-A clone in neonatal intensive-care units. Clin Microbiol Infect. 2016. 22:46–52.

13). Hornik CP., Fort P., Clark RH., Watt K., Benjamin DK Jr., Smith PB, et al. Early and late onset sepsis in very-low-birth weight infants from a large group of neonatal intensive care units. Early Hum Dev. 2012. 88(Suppl 2):S69–74.

14). Mularoni A., Madrid M., Azpeitia A., Valls i Soler A. The role of coagulase-negative staphylococci in early onset sepsis in a large European cohort of very low birth weight infants. Pediatr Infect Dis J. 2014. 33:e121–5.

15). Stoll BJ., Hansen N., Fanaroff AA., Wright LL., Carlo WA., Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002. 347:240–7.

16). Van den Hoogen A., Gerards LJ., Verboon-Maciolek MA., Fleer A., Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2010. 97:22–8.

17). Schmidt BK., Kirpalani HM., Corey M., Low DE., Philip AG., Ford-Jones EL. Coagulase-negative staphylococci as true pathogens in newborn infants: a cohort study. Pediatr Infect Dis J. 1987. 6:1026–31.

18). Sohn AH., Garrett DO., Sinkowitz-Cochran RL., Grohskopf LA., Levine GL., Stover BH, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr. 2001. 139:821–7.

19). Gray JE., Richardson DK., McCormick MC., Goldmann DA. Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatrics. 1995. 95:225–30.

20). Freeman J., Goldmann DA., Smith NE., Sidebottom DG., Epstein MF., Platt R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med. 1990. 323:301–8.

21). Johnson-Robbins LA., el-Mohandes AE., Simmens SJ., Keiser JF. Staphylococcus epidermidis sepsis in the intensive care nursery: a characterization of risk associations in infants < 1,000 g. Biol Neonate. 1996. 69:249–56.

22). Goldmanln DA. Bacterial colonization and infection in the neonate. Am J Med. 1981. 70:417–22.

23). Horan TC., Andrus M., Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008. 36:309–32.

24). Isaacs D. Australasian Study Group For Neonatal Infections. A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units. Arch Dis Child Fetal Neonatal Ed. 2003. 88:F89–93.

25). Ng PC., Chow VC., Lee CH., Ling JM., Wong HL., Chan RC. Persistent Staphylococcus capitis septicemia in a preterm infant. Pediatr Infect Dis J. 2006. 25:652–4.

Fig. 1

Week of life at onset of late-onset sepsis.

Table 1.

The Characteristics of Patients

Characteristics	Number
Gestational age (weeks)	25⁺⁶ (21⁺²-31⁺²)
Birth body weight (g)	799.6 (340-1390)
Gender (male:female)	34:26 (1.3:1)
Mean Apgar score at 1 minute	3.0 (1-6)
Mean Apgar score at 5 minutes	5.5 (3-8)
Delivery mode (vaginal:cesarean section, %)	22:38 (37:63)
Singleton:Multiple gestation (%)	46:14 (77:23)
Inborn:Outborn (%)	57:3 (95:5)

Table 2.

Causative Organisms of Late-onset Sepsis

Organism				Value (n=84)
Gram (+)	Staphylococcus		S. aureus	8 (9.5)
		CoNS	S. capitis	26 (30.9)
			S. epidermidis	11 (13.0)
			S. haemolyticus	4 (4.8)
			S. warneri	1 (1.2)
	Streptococcus		S. mitis	1 (1.2)
	Enterococcus		E. faecalis	6 (7.1)
			E. faecium	2 (2.4)
Gram (-)	Escherichia		E. coli	4 (4.8)
	Klebsiella		K. pneumoniae	3 (3.6)
			K. oxytoca	2 (2.4)
	Acinetobacter		A. baumannii	3 (3.6)
	Ochrobactrum		O.anthropi	1 (1.2)
Fungus	Candida		C. parapsilosis	6 (7.1)
			C. albicans	2 (2.4)
			C. glabrata	2 (2.4)
			C. famata	1 (1.2)
			C. sphaerica	1 (1.2)

Values are presented as number (%).

Table 3.

Causes of Death in Very Low Birth Weight Infants with Staphylococcus capitis Late-onset Sepsis

Patient	GA (weeks)	BWT Combined major morbidities ) (g)	Cause of death
Patient 1	24⁺⁰	460 RDS, PDA, sepsis	Heart failure
Patient 2	24⁺³	740 RDS, PDA, BPD, pulmonary hemorrh-	Sepsis
		age
Patient 3	28⁺⁴	660 RDS, PDA, BPD, NEC	Sepsis
Patient 4	22⁺⁶	600 RDS, PDA, BPD, IVH, NEC, sepsis	Renal failure
Patient 5	22⁺⁶	540 RDS, PDA, BPD, IVH, NEC, sepsis	Renal failure
Patient 6	26⁺⁶	340 RDS, PDA, BPD, infective endocardi-	ICH
		tis, pulmonary hemorrhage, sepsis

Abbreviations: GA, gestational age; BWT, body weight; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ICH, intracerebral hemorrhage.

Table 4.

Antibiotics Resistance of Staphylococcus capitis and Staphylococcus epidermidis

Antibiotics	Staphylococcus capitis (n=26)	Staphylococcus epidermidis (n=11)	P-value
Clindamycin	21 (80.8)	3 (27.3)	0.006
Ciprofloxacin	25 (96.2)	2 (18.2)	0.000
Erythromycin	20 (76.9)	4 (36.4)	0.028
Fusidic acid	18 (69.2)	6 (54.5)	0.225
Gentamicin	19 (73.1)	6 (54.5)	0.474
Linezolid	0 (0.0)	0 (0.0)	-
Oxacillin	26 (100.0)	11 (100.0)	-
Benzylpenicillin	26 (100.0)	11 (100.0)	-
Rifampicin	2 (7.7)	1 (9.1)	1.000
Bactrim	1 (3.8)	1 (9.1)	0.512
Vancomycin	0 (0.0)	0 (0.0)	-

Values are presented as number (%).

TOOLS

Similar articles