STAPHYLOCOCCUS-EPIDERMIDIS SEPSIS IN THE INTENSIVE-CARE NURSERY - A CHARACTERIZATION OF RISK ASSOCIATIONS IN INFANTS LESS-THAN-1.000 G

We undertook to determine Staphylococcus epidermidis colonization patt erns and risks of sepsis in a cohort of 82 consecutive intensive care nursery admissions (birth weight 1,285 + +/- 57 g), with 24 infants we ighing <1,000 g at birth. Colonization was determined by skin and stoo l cultures collected at three time points. Multiple neonatal variables were classified into three intervals preceding the time of sample col lection including the occurrence of S. epidermidis sepsis. 16 infants (20%) developed S. epidermidis sepsis. 81% of these episodes occurred in infants <1,000 g. Skin colonization was nearly universal at all sam pling points. Rectal colonization was 63.6% initially (10 +/- 0.4 days ), then declined to 32% by the third sample (37 + 0.4 days). Neither p revalence of skin nor rectal colonization influenced the incidence of sepsis significantly. Statistically significant risk associations for sepsis for the entire intensive care nursery population included: low birth weight, gestational age, presence of a central line, and delayed feeding. For infants <1,000 g the occurrence of sepsis during the sec ond study time period (54% of the episodes) was associated with preced ing steroid exposure. During the third study time period, birth weight and delayed attainment of full enteral feeds showed a statistically s ignificant association with sepsis. We conclude that infants <1,000 g are at an increased risk of S. epidermidis sepsis. Extreme immaturity, steroid therapy, and prolonged hyperalimentation are all significant risk associations.