BACKGROUND: Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. Whilst 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 WHO guidelines. RESULTS: CoNS was isolated from blood culture in 995/9552 (10%) neonates. Case fatality amongst neonates with CoNS isolated from blood did not differ from other neonatal admissions (p=0.2), and duration of admission was not prolonged (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 WHO guidelines for hospital care in this setting. There is no evidence that first-line antimicrobial treatment guidelines should be altered to increase cover for coagulase- negative staphylococcal infections in neonates in this setting.
Seale, A.C., Obiero, C.W., Jones, K., Barsosio, H.C., Thitiri, J., Ngari, M., Morpeth, S., Mohammed, S., Fegan, G., Mturi, N., Berkley, J.A.