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      Significância clínica de estafilococos coagulase-negativa isolados de recém-nascidos Translated title: Clinical significance of coagulase-negative staphylococci isolated from neonates

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          Abstract

          Objetivo: avaliar a significância clínica de estafilococos coagu-lase-negativa (ECN) isolados de processos infecciosos em recém-nascidos da unidade neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Método: as linhagens de ECN isoladas foram identificadas e classificadas em significativas e contaminantes, com base em uma série de dados clínicos e laboratoriais obtidos dos prontuários dos pacientes internados na unidade neonatal. Foram pesquisados os dados referentes a fatores perinatais de risco para infecção, evolução clínica, alterações do hemograma e/ou positividade de proteína C-reativa e antibioticoterapia. Resultados: das 117 linhagens de ECN isoladas, 60 (51,3%) foram classificadas como significativas, e 57 (48,7%) como contaminantes. Das 54 crianças com infecção por ECN, 43 (79,6%) eram prematuras, e 27 (50,0%) tiveram peso ao nascimento < 1.500g. A maioria das crianças com infecção por ECN estava submetida a dois ou mais procedimentos invasivos (77,8%), incluindo o uso de cateter (88,9%), nutrição parenteral (64,8%) e ventilação mecânica (61,1%). O S. epidermidis foi a espécie mais freqüentemente isolada (77,8%), e mais associada com infecção (86,7%) do que com contaminação (68,4%). Outras espécies de ECN, incluindo duas linhagens de S. haemolyticus, três linhagens de S. lugdunensis, uma linhagem de S. simulans, uma de S. warneri e uma linhagem de S. xylosus também foram isoladas de crianças com evidência clínica de pneumonia, enterocolite necrosante e sepse. Conclusão: a maioria dos recém-nascidos com infecção por ECN apresentou fatores predisponentes importantes para a instala-ção do processo infeccioso, incluindo o peso de nascimento <1.500g, a não remoção de corpo estranho e a antibioticoterapia prévia. A identificação de espécies de ECN constitui um marcador útil de infecção, visto que o S. epidermidis foi o agente etiológico mais freqüentemente associado aos processos infecciosos.

          Translated abstract

          Objective: to evaluate the clinical significance of coagulase-negative staphylococci (CNS) isolated from newborns' infections at Neonatal Unit of Hospital das Clínicas da Faculdade de Medicina de Botucatu. Methods: the CNS strains isolated were identified and classi-fied as clinically significant and contaminant, based on a series of clinical and laboratory data obtained from patients who stayed in the Neonatal Unit. The following data were analyzed: risk factors for infections, clinical evolution, abnormal blood cell counts and/or C-reactive protein e antibiotic therapy. Results: among the 117 CNS strains isolated, 60 (51.3%) were classified as significant and 57 (48.7%) as contaminant. Among the 54 infants infected by CNS, 43 (79.6%) presented very low birthweight (< 1,500g). Most of the infants infected by CNS were submitted to two or more invasive procedures (77.8%), including use of catheter (88.9%), parenteral nutrition (64.8%) and mechanical ventilation (61.1%). Staphylococcus epidermidis was the most frequently isolated species (77.8%) and more often associated with infection (86.7%) than with contamination (68.4%). Other species of CNS, including two strains of S. haemolyticus, three strains of S. lugdunensis, one strain of S. simulans, one strain of S. warneri and one strain of S. xylosus were also isolated from infants with clinical evidence of pneumonia, necrotizing enterocolitis and sepsis. Conclusions: most newborns infected by CNS presented impor-tant risk factors for infection onset, including birthweight < 1,500g, foreign body presence and previous use of antibiotics. The identifi-cation of CNS species constitutes a useful marker of infection, since S. epidermidis was the species more frequently associated with infection.

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          Most cited references59

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          Modelling Binary Data

          D. Collett (1991)
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            The neonatal blood count in health and disease. I. Reference values for neutrophilic cells.

            Reference ranges for absolute total neutrophils/mm3, absolute immature neutrophils/mm3, and the fraction of immature to total neutrophils (I:T proportion) during the first 28 days of life are developed from 585 peripheral blood counts obtained from 304 normal neonates and 320 counts obtained from 130 neonates with perinatal complications demonstrated to have no statistically significant effect on neutrophil dynamics. Perinatal factors other than bacterial disease which significantly alter neutrophil dynamics include maternal hypertension, maternal fever prior to delivery, hemolytic disease, and periventricular hemorrhage. The predictive value of these reference ranges in identifying bacterial disease in the first week of age varies with the neutrophil factor evaluated and the clinical setting. Neutropenia in the presence of respiratory distress in the first 72 hours had an 84% likelihood of signifying bacterial disease, whereas neutropenia in the presence of asphyxia had a 68% likelihood of signifying bacterial disease. An abnormal I:T proportion had an accuracy of 82% and 61%, respectively, in the same clinical settings. Elevations of either immature or total neutrophils were less specific. Interpretation of abnormal neutrophil factors must include consideration of both infectious and noninfectious perinatal events.
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              Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.

              Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infection (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late-onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.000 1), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection. Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbp
                Revista de la Sociedad Boliviana de Pediatría
                Rev. bol. ped.
                Sociedad Boliviana de Pediatría (La Paz, , Bolivia )
                1024-0675
                January 2004
                : 43
                : 1
                : 42-43
                Affiliations
                [03] Botucatu orgnameUNESP orgdiv1Instituto de Biociências orgdiv2Dep. de Bioestatística
                [01] Botucatu orgnameUNESP orgdiv1Instituto de Biociências orgdiv2Dep. de Microbiologia e Imunologia
                [02] Botucatu orgnameUNESP orgdiv1Faculdade de Medicina orgdiv2Dep. de Pediatria
                Article
                S1024-06752004000100017
                00dc22c4-2e1d-4462-8b6f-749d63400c0a

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 13 December 2001
                : 05 June 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 2
                Product

                SciELO Bolivia


                recém-nascido,infecção,estafilococos coagulase-negativa,fatores de risco,neonates,infection,coagulase-negative staphylococci,risk factors

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