Neonatal intensive care unit bacteremia: Emergence of gram-positive bacteria as major pathogens

An outbreak of nosocomial Staphylococcus epidermidis bacteremia in a neonatal intensive care unit in 1981 was epidemiologically linked to use of Broviac central venous catheters (p = 0.05) and prompted a review of nosocomial infection surveillance data for the previous 6 years, which indicated a striking shift from gram-negative to gram-positive bacteria, especially coagulase-negative staphylococci, as major bloodstream pathogens. In a case-control study with 68 patients with bacteremia between 1979 and September 1981 and 64 control patients, stratified by birth weight, three risk factors were identified: use of Broviac central venous catheters, surgical procedures, and intravenous hyperalimentation. The risk factors varied with the birth weight category. In the group of cases and controls with birth weights