Nosocomiale sepsis in de neonatale intensieve zorg

In neonatal intensive care units (nicu's) a shift has occurred from early-onset to late-onset sepsis. In addition, the incidence of nosocomial sepsis increased to 1 in every 6 admitted patients in many units. In our nicu coagulase-negative staphylococci and Staphylococcus aureus are major causative microorganisms of nosocomial infections. Gram-negative microorganisms and Candida species occur less frequently as causative microorganism. Prospectively collected data from all 6742 patients admitted to our nicu from 1978-1998 revealed prematurity and low birth weight as the most important risk factors for nosocomial infections. Other factors were instrumentation, such as central venous catheters, intubation, artificial ventilation and total parenteral nutrition. During a period of 10 years (1988-1998) increasing resistance to antibiotics has been observed in our nicu, particularly among coagulase-negative staphylococci (against amoxicillin-clavulanic acid, cloxacillin and cephalothin) and among Escherichia coli blood isolates, which were fully susceptible to amoxicillin-clavulanic acid during 1988-1993, but developed resistance (38% of blood isolates) during the next five years. We recently published our results with successful treatment of patients with sepsis due to coagulase-negative staphylococci with cephalothin, despite resistance of the blood isolate in vitro.39