676. What is the Cost of Coagulase-Negative Staphylococcal Sepsis in the NICU?
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Background: Coagulase-negative staphylococci (CONS) are the most common cause of both late-onset sepsis and culture contamination in the neonatal intensive care unit (NICU). Definitive treatment of proven CONS infection usually requires vancomycin. Whether CONS increases the risk for neonatal mortality is unclear. The objective of this study was to determine if CONS sepsis is associated with increased mortality in a cohort of very-low-birth-weight (VLBW, <1500 g) infants

Methods: Retrospective cohort study of VLBW infants admitted to the Scott & White Memorial Hospital NICU from 1989 through 2015. Infants were excluded if they had major congenital anomaly or died before age 7 days. Demographic, clinical, and laboratory data were reviewed. CONS was considered a pathogen if recovered from ≥2 cultures, or from 1 culture if the infant had signs of sepsis and received ≥5 days of effective antimicrobial therapy. Bronchopulmonary dysplasia (BPD) was defined as need for oxygen at 36 weeks post-menstrual age. Retinopathy of prematurity (ROP) was defined as need for treatment. Logistic regression was used to examine factors associated with mortality and comorbidities.

Results: 2242 VLBW infants were included, and 285 (12.7%) had late-onset sepsis. CONS (125, 44%), S. aureus (52, 18%), E. coli (36, 13%) and GBS (19, 7%) were the most commonly recovered organisms. Crude mortality was 2.5% for infants without sepsis, 1.6% for CONS sepsis, 5.4% for other gram-positive organisms, and 19.1% for gram-negative organisms. In multivariable analysis, after controlling for gestational age and birth weight, CONS sepsis was associated with longer length of stay but not risk for BPD or ROP. CONS sepsis was not associated with mortality (OR 0.6 [95% CI 0.2-2.6]), but proven sepsis with other organisms was (OR 4.5 [95% CI 2.6-8.0]).

Conclusion: CONS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction antibiotic stewardship strategies in the NICU.

Joseph Cantey, MD, FIDSA1, Ram Kaligiri, MD2, Timothy Carder, MD2, Jessica Pruszynski, Ph. D3 and Lea Mallett, PhD1, (1)Pediatrics, Texas A&M Health Science Center, TEMPLE, TX, (2)Texas A&M Health Science Center, TEMPLE, TX, (3)Biostatistics, Baylor/Scott & White, TEMPLE, TX

Disclosures:

J. Cantey, None

R. Kaligiri, None

T. Carder, None

J. Pruszynski, None

L. Mallett, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.