Abstract:
Background: Neonatal mortality remains high in sub-Saharan Africa, and a third of
deaths are estimated to result from infection. While coagulase-negative staphylococci
(CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need
for early anti-Staphylococcal treatment in empiric antibiotic guidelines, is unknown in
sub-Saharan Africa.
Methods: We examined systematic clinical and microbiologic surveillance data from all
neonatal admissions to Kilifi County Hospital (1998-2013) to determine associated case
fatality and/or prolonged duration of admission associated with CoNS in neonates treated
according to standard World Health Organization guidelines.
Results: CoNS was isolated from blood culture in 995 of 9552 (10%) neonates. Case
fatality among neonates with CoNS isolated from blood did not differ from other
neonatal admissions (P = 0.2), and duration of admission was not prolonged [odds ratio
(OR) = 0.9 (0.7-1.0), P = 0.040]. Neonates with CoNS were more likely to have
convulsions [OR = 1.4 (1.0-1.8), P = 0.031] but less likely to have impaired
consciousness or severe indrawing [OR = 0.8 (0.7-0.9), P = 0.025; OR = 0.9 (0.7-1.0), P
= 0.065].
Conclusions: CoNS isolation in blood cultures at admission was not associated with
adverse clinical outcomes in neonates treated according to standard World Health
Organization guidelines for hospital care in this setting. There is no evidence that firstline antimicrobial treatment guidelines should be altered to increase cover for CoNS
infections in neonates in this setting.