INTRAVENOUS LIPID EMULSIONS ARE THE MAJOR DETERMINANT OF COAGULASE-NEGATIVE STAPHYLOCOCCAL BACTEREMIA IN VERY-LOW-BIRTH-WEIGHT NEWBORNS

Background. Intravenous lipid emulsions and the iv catheters through w hich 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 prac tice is changing, and these and other interventions may have different effects in the current setting, Objectives, We determined the indepen dent 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 <1 500 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 p airs of matched controls. Adjusted relative odds of bacteremia were es timated 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 regres sion to adjust for indicators of severity of illness, two procedures w ere independently associated with subsequent risk of CONS bacteremia a t any time during hospitalization: iv lipids, odds ratio (OR) = 9.4 [9 5% confidence interval (CI) 1.2 to 74.2]; and any surgical or percutan eously placed central venous catheter, OR = 2.0 (95% CI 1.1 to 3.9). C onsidering only the week immediately preceding bacteremia, the indepen dent risk factors were: mechanical ventilation, OR = 3.2 (95% CI 1.3 t o 7.6); and short peripheral venous catheters, OR = 2.6 (95% CI 1.0 to 6.5), Conclusions, During the last decade exposure to iv lipids any t ime during hospitalization has become an even more important risk fact or for CONS bacteremia (OR = 9.4), Of these bacteremias 85% are now at tributable to lipid therapy, In contrast the relative importance of in travenous catheters as independent risk factors has declined. Mechanic al ventilation in the week before bacteremia has emerged as a risk fac tor for bacteremia.