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Journal of Clinical Microbiology, September 1998, p. 2485-2490, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Persistence of Clones of Coagulase-Negative Staphylococci among Premature Neonates in Neonatal Intensive Care Units: Two-Center Study of Bacterial Genotyping and Patient Risk Factors

Clementien L. Vermont,1 Nico G. Hartwig,1,* André Fleer,2 Peter de Man,3 Henri Verbrugh,3 John van den Anker,4 Ronald de Groot,1 and Alex van Belkum3

Department of Medical Microbiology, Wilhelmina Children's Hospital, University Hospital Utrecht, Utrecht,2 and Divisions of Pediatric Infectious Diseases1 and Neonatology,4 Department of Pediatrics, Sophia Children's Hospital, and Department of Medical Microbiology and Infectious Diseases,3 University Hospital Rotterdam, Rotterdam, The Netherlands

Received 2 February 1998/Returned for modification 15 March 1998/Accepted 29 May 1998

From 1 January 1995 until 1 January 1996, we studied the molecular epidemiology of blood isolates of coagulase-negative staphylococci (CoNS) in the Neonatal Intensive Care Units (NICUs) of the Sophia Children's Hospital (SCH; Rotterdam, The Netherlands) and the Wilhelmina Children's Hospital (WCH; Utrecht, The Netherlands). The main goal of the present study was to detect putatively endemic clones of CoNS persisting in these NICUs. Pulsed-field gel electrophoresis was used to detect the possible presence of endemic clones of clinical significance. In addition, clinical data of patients in the SCH were analyzed retrospectively to identify risk factors for the acquisition of positive blood cultures. In both centers, endemic CoNS clones were persistently present. Thirty-three percent of the bacterial isolates derived from blood cultures in the SCH belonged to a single genotype. In the WCH, 45% of all bacterial strains belonged to a single clone. These clones were clearly different from each other, which implies that site specificity is involved. Interestingly, we observe that the clonal type in the SCH differed significantly from the incidentally occurring strains with respect to both the average pH and partial CO2 pressure of the patient's blood at the time of bacterial culture. We found that the use of intravascular catheters, low gestational age, and a long hospital stay were important risk factors for the development of a putative CoNS infection. When the antibiotic susceptibility of the bacterial isolates was assessed, a clear correlation between the nature of the antibiotics most frequently used as a first line of defense versus the resistance profile was observed. We conclude that the intensive use of antibiotics in an NICU setting with highly susceptible patients causes selection of multiresistant clones of CoNS which subsequently become endemic.

* Corresponding author. Mailing address: Department of Pediatrics, Sophia Children's Hospital, University Hospital Rotterdam, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Phone: 31-10-4636948. Fax: 31-10-4636449. E-mail: hartwig{at}alkg.azr.nl.

Journal of Clinical Microbiology, September 1998, p. 2485-2490, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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