Intravenous Lipid Emulsions Are the Major Determinant of Coagulase-Negative Staphylococcal Bacteremia in Very Low Birth Weight Newborns

Pediatr Infect Dis J. 1998 Jan;17(1):10-7. doi: 10.1097/00006454-199801000-00004.

Abstract

Background: Intravenous lipid emulsions and the i.v. catheters through which they were administered were the major risk factors for nosocomial coagulase-negative staphylococcal (CONS) bacteremia among newborns in our neonatal intensive care units a decade ago. However, medical practice is changing, and these and other interventions may have different effects in the current setting.

Objectives: We determined the independent risk factors for CONS bacteremia in current very low birth weight newborns after adjusting for severity of underlying illness.

Methods: We surveyed 590 consecutively admitted newborns with birth weights < 1500 g hospitalized in 2 neonatal intensive care units and conducted a case-control study in a sample of 74 cases of CONS bacteremia and 74 pairs of matched controls. Adjusted relative odds of bacteremia were estimated for a number of attributes and therapeutic interventions in 2 time intervals before CONS bacteremia: any time before bacteremia and the week before bacteremia.

Results: Using conditional logistic regression to adjust for indicators of severity of illness, two procedures were independently associated with subsequent risk of CONS bacteremia at any time during hospitalization: i.v. lipids, odds ratio (OR) = 9.4 [95% confidence interval (CI) 1.2 to 74.2]; and any surgical or percutaneously placed central venous catheter, OR = 2.0 (95% CI 1.1 to 3.9). Considering only the week immediately preceding bacteremia, the independent risk factors were: mechanical ventilation, OR = 3.2 (95% CI 1.3 to 7.6); and short peripheral venous catheters, OR = 2.6 (95% CI 1.0 to 6.5).

Conclusions: During the last decade exposure to i.v. lipids any time during hospitalization has become an even more important risk factor for CONS bacteremia (OR = 9.4). Of these bacteremias 85% are now attributable to lipid therapy. In contrast the relative importance of intravenous catheters as independent risk factors has declined. Mechanical ventilation in the week before bacteremia has emerged as a risk factor for bacteremia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteremia / etiology*
  • Coagulase / analysis*
  • Cross Infection / etiology
  • Fat Emulsions, Intravenous / adverse effects*
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Risk Factors
  • Staphylococcal Infections / etiology*

Substances

  • Coagulase
  • Fat Emulsions, Intravenous