Research articles

By Dr. Suneel Mundkur , Dr. B Ramesh , Dr. L Leslie
Corresponding Author Dr. Suneel Mundkur
Pediatrics, KMC Manipal, - India
Submitting Author Dr. Suneel Mundkur
Other Authors Dr. B Ramesh
Pediatrics, KMC Manipal, - India

Dr. L Leslie
Pediatrics, KMC Manipal, - India


CONS, Neonatal ICU, Sepsis, Antibiotic Sensitivity

Mundkur S, Ramesh B, Leslie L. Coagulase Negative Staphylococcus (CONS) Infection in Neonatal ICU.. WebmedCentral PAEDIATRICS 2011;2(12):WMC002829
doi: 10.9754/journal.wmc.2011.002829

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 31 Dec 2011 04:10:54 AM GMT
Published on: 31 Dec 2011 10:32:10 AM GMT


Objective: To study the mortality in CONS infection in neonates in relation to clinical and hematological profile.
Design-Retrospective study.
Methods: A total of 131 newborns admitted to the NICU of Kasturba Hospital, Manipal between March 2000 and February 2005 whose blood culture had grown CONS were included in the study group. They were classified into two groups-1) Neonates who recovered 2) Neonates who died of infection or discharged at request in a moribund state. The clinical features, sepsis screen parameters, birth weight, mode and place of delivery and interventions in relation to the outcome were analyzed statistically. Antibiotic sensitivity pattern was studied.
Results: Out of 131 babies studied, mortality was observed in 13 cases (9.9%). The mortality in VLBW and LBW babies was 30.8% (n=4) and 7.9% (n=3) respectively. Higher mortality of 12.7% (n=10) was observed in babies delivered vaginally as compared to 5.8% (n=3) in those born by Caesarian section. Mortality in preterm babies was 16.7% (n=5) as against 7.9% (n=8) in term babies. Mortality rate was 25% (n=7) in babies with 3 or more positive sepsis parameters as compared to 5.8% (n=6) in babies with less than 3 positive parameters. A mortality of 17.4% (n=12) was seen in babies with clinical features of sepsis compared to 1.6% (n=1) in those without any clinical features. Morality rates were 12% (n=5) and 8.6% (n=8) in outborns and inborns respectively. Mortality rate of 33.3%(n=12) was observed in babies wherein interventions like ICD, umbilical catheterisation, arterial cannulation, mechanical ventilation were done compared to 1.1%(n=1) in babies where no interventions were done. In the present study the Antibiotic sensitivity pattern was Amikacin 79%(n=113), Gentamicin 73.4%(n=105) Cefotaxime 62%(n=89), Ampicillin 60.1%(n=86), Cefuroxime 49%(n=71).
Conclusions: In CONS infection mortality was higher in LBW and VLBW babies, vaginal deliveries and outborns. Prognosis worsens if 3 or more sepsis screen parameters or clinical manifestation of sepsis are present. Mortality rate was higher in babies who have undergone interventions. Amikacin was the most sensitive antibiotic both invitro and in vivo.


Aim of the Study: To Study the outcome of CONS infection in neonates in relation to clinical and hematological profile.
Type of Study: Retrospective study.
Material and Methods: - The present study was conducted in NICU of Kasturba Hospital, Manipal
Inclusion Criteria: All newborns admitted to NICU whose blood cultures had grown CONS during the hospital stay were included.
Exclusion Criteria: Newborns with culture other than CONS were excluded.
These newborns were classified into 2 groups; 1) Neonates who recovered 2) Neonates who died of infection or discharged at request in a moribund state. The clinical features of sepsis, sepsis screen parameters (A total count beyond 4000 -21000/cmm, a platelet count of < 1,50,000/cmm, micro ESR of > 10 mm in one hour, Band neutrophil ratio of ≥0.2, CRP > 6 mg/L and the presence of Toxic granulations and cytoplasmic vacuolations in the peripheral smear), birth weight(>2500g, 1500-2499g and


Period of study: 5 years (from March 2000 to February 2005).
Total number of cases studied: 131.
Total no. of Deaths or Discharge at request: 13
Mortality Rate: 9.9%
Both death and discharged at request in a moribund state were considered as mortality
The mortality rate was 7.9% and 30.8% in patients with Birth weight of 1500-2499g and VLBW group respectively (p
Higher mortality was observed in babies delivered vaginally (12.7%) as compared to those born by caesarean section (5.8%) (P
Mortality in preterm babies was 16.7% as against 7.8% in term babies(p
Higher rate of mortality was observed in babies who presented with clinical features of sepsis.(p
Mortality rate was 25% in babies with 3 more sepsis screen parameters as compared to 5.8% in babies with less than 3 parameters (p
Mortality rate was higher (12%) in outborn babies referred to our hospital when compared to Inborn babies (8.6%) (p
Mortality rate was more in babies in whom interventions were done compared to whom the interventions were not performed.
Co Amoxyclav, Ampicillin, Cefotaxime, Cefuroxime, Amikacin and Gentamicin showed a sensitivity of 59.7 %, 69.3 %, 80.2 %, 66.3 % 87.6% and 80.2 % of the CONS isolates respectively where sensitivity was done. None of the CONS isolates showed resistance to Vancomycin, Tobramycin and Netilmycin
Conclusions :
The mortality rate of Neonatal CONS infection in the present study was 9.9% (13 out of 131 babies).
The mortality rate was higher in babies with LBW and VLBW as compared to newborns with normal birth weight.
Prognosis worsens of CONS infections in Neonates is associated with 3 or more sepsis screen parameters indicating CONS sepsis.
Mortality in CONS infection is higher in these patients who have undergone interventions.
None of the CONS isolates were resistant to Vancomycin, Tobramycin and Netilmycin


1. Jean- Baptiste et al Coagulase-negative staphylococcal infections in the neonatal intensive care unit.Infect Control Hosp Epidemiol.2011 Jul;32(7):679-86.
2. Marc P Blayney, Mahmud Al Madani, Coagulase-negative staphylococcal infections in a neonatal intensive care unit: In vivo response to cloxacillin Paediatr Child Health. 2006 December; 11(10): 659–663.
3. JE Gray, DK Richardson, MC McCormick and DA Goldmann Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome Pediatrics. 1995 Feb; 95(2):225-30
4. Baumgart et al. Sepsis with coagulase-negative staphylococci in critically ill newborns. Am J Dis Child. 1983 May; 137(5):461-3.

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CONS infection in NICU
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