METHICILLIN-RESISTANT STAPHYLOCOCCAL SEPTICEMIA IN NEWBORNS HOSPITALIZED IN NICU
Genge A. Mikusz G. Stojewska M. Godula-Stuglik U.
II Department of Pediatrics, NICU, Zabrze, Poland
OBJECTIVE: To determine the morbidity rate, clinical symptoms, biochemical and haematological disorders and treatment results of methicillin-resistant staphylococcal septicemia in newborns admitted to the NICU.
METHODS: Prospective chart review of newborns diagnosed with staphylococcal septicemia between 1997 and 1998
MATERIAL: The study population consisted of 121 (71 boys, 50 girls) newborns (66% of all septic neonates treated in the NICU within two years). Birth asphyxia in 51%, others obstetric complications in 82 %, very low birth weight (<1500 g.) in 25% of cases were found. In 60% of them early-onset septicemia was diagnosed.
RESULTS: Most frequent Staphylococcus strain isolated from the blood was Staph. epidermidis (95 cases). Staph. haemolyticus in 10, Staph. hominis in 11, Staph. wamerii in 2, Staph. sciurii, capitis, xylans in 3 cases were noted. Staph. epidermidis strains were resistant to gentamycin and tobramycin in 90%, to amikacin and netylimycin in 83%, to lincomycin in 52%, to rifampicin in 35%, to teicoplamin in 14% and one strain to vancomycin. All the others Staphylococcus strains were sensitive to vancomycin teicoplamin so as rifampicin and resistant to oxacillin and lincomycin.
Typical clinical symptoms included pneumonia (63%), gastrointestinal disorders (56%, NEC in 7 cases), shock (32%) jaundice and hepatosplenomegaly (38%), purulent meningitis (18%). Metabolic acidosis (50%), glycaemia disorders (20%), increase of CRP concentration (54%) as biochemical abnormalities were most often stated. Leucocytosis (s20,0) in 37% of cases was noted. Mechanical wentilation in 62 septic neonates and total parenteral nutrition in 51 were necessary. In the course of treatment died 12 (9,9%) newborns despite of the intensive antibiotic therapy according to antibiograms: 8 prematures (4 with birth weight <1000g., intraventricular haemorrage and severe RDS, 2 with BPD, 2 with multiply anomalies), 2 hypotrophic full-term neonates with congenital heart defect and 2 full-term (1 with severe birth asphyxia and 1 with NEC complicated by intestinal performation and peritonitis).