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The incidence of neonatal sepsis in developed countries is about 6–9 per 1000 live births. In the UK, it is 8 per 1000 live births. The two most common causes of late onset neonatal sepsis in higher income countries are first coagulase-negative staphylococci and second Staphylococcus aureus. A report from the UK neonatal infection surveillance network suggests that an antistaphylococcal antibiotic should be included in empirical therapy for late onset neonatal sepsis in preterm infants (Stefania Vergnano and colleagues. The Pediatric Infectious Disease Journal 2011;30: 850–4).
Between 2004 and 2009 a total of 117 episodes of culture-proved S aureus infection (blood or cerebrospinal fluid cultures) were reported in 116 infants from 13 neonatal units. The median gestational age of these infants was 27 weeks and median birthweight 850 g. The incidence of S aureus infection was 0.6 per 1000 live births overall and 23 per 1000 among infants with a birthweight <1500 g. Most (94%) of the infections were of late onset (>48 h after birth). In all, eight infants had methicillin-resistant (MRSA) infections but only one of these was in the late onset group. All seven children with early onset (<48 h) S aureus infections had MRSA infections and their median gestational age was 38.5 weeks. Most infants (71%) were receiving respiratory support at the time of S aureus culture and half had a central line. Forty-one of 91 infants (45%) had evidence of focal infection (skin, soft tissue, bone, joint or pneumonia) but otherwise the clinical features were non-specific. Eighteen infants died, but only four deaths were considered to have been caused by the infection, all in infants with late onset infection. All four of these infants were infected with methicillin sensitive S aureus and presented with non-specific signs. These researchers suggest that all preterm infants with late onset sepsis should have an antibiotic regimen including an antistaphylococcal agent.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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