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557 INFECTION IN NEWBORN INFANTS - A CHANGING PATTERN IN A SPECIAL CARE UNIT (SCU)

An analysis of bacterial infection in the intensive and intermediate care nurseries (special care unit) of the Hospital of the University of Pennsylvania was made over a 3 year period to determine if changes in the predominant organisms for neonatal sepsis had occurred. From Jan. 1982 to Sept. 1984, 98 bacteremias were identified in 2571 infants, an incidence of 3.8/100 SCU admissions and 11.8/1000 hospital births was noted. Eighty-eight percent of all bacteremias were due to gram positive organisms, with coagulase negative staphylococcus (CNS) and beta hemolytic streptococcus Group B (GBS) being the predominant organisms. Paucity of gram negative infection was noted. CNS was responsible for 42% of bacteremias and 75% of nosocomial infections, while GBS was responsible for 32% of bacteremias and 78% of early infections. Incidence of GBS disease was 3.8/1000 hospital births; however, if GBS antigenuria as identified by latex agglutination was included, incidence rose to 5.5/1000 hospital births. Mortality from GBS was 11%. The majority of infants with CNS were 1600 gms. Although mortality was low, considerable morbidity was noted. Forty-two percent of infants with clinical signs of necrotizing enterocolitis were noted to have CNS bacteremia, and 32% of localized infections were due to CNS.These data suggest the changing pattern of infection and emergence of coagulase-negative staphylococcus as a pathogen. In view of the significant morbidity caused by CNS among low birth weight infants, antibiotic therapy for suspected nosocomial infection should include coverage against this ubiquitous organism.