Late-onset neonatal sepsis due to multiply-resistant coagulase-negative staphylococci.
A cluster of septic episodes that were caused by coagulase-negative staphylococci occurred in eight patients, over a six-month period from August 1, 1984 to January 31, 1985, in a Brisbane neonatal intensive-care unit where sepsis which was due to these organisms previously was uncommon. The organisms were universally-resistant to tobramycin (the aminoglycoside agent that was used at that time) and were variably-resistant to gentamicin, flucloxacillin and cephalothin. All organisms were sensitive to netilmicin, vancomycin, fusidic acid and rifampicin. The affected infants were all of 32 weeks' or less gestation and most of them weighed less than 1500 g at birth. All neonates had been ventilated artificially and had had long intravascular lines. Two infants had ventriculoperitoneal shunts that had been infected with coagulase-negative staphylococci--a potentially-important problem that has not been noted in premature infants in previous reports. Our experience demonstrates that it is important to consider the patterns of resistance to aminoglycoside as well as to beta-lactam antibiotic agents for the empirical therapy of septic episodes and for neurosurgical prophylaxis in nurseries where coagulase-negative staphylococci are emerging as common nosocomial pathogens.