VLBW Hospitalized Infants Face High S aureus Infection Risk
Late-onset invasive Staphylococcus aureus infections affected a substantial proportion of infants hospitalized in neonatal intensive care units (NICUs), with infants with very low birth weight (VLBW; < 1500 g) experiencing a much higher incidence than those with a birth weight ≥ 1500 g. VLBW babies accounted for more than three fourths of infections and the majority of attributable deaths.
METHODOLOGY:
Researchers conducted a retrospective cohort study to determine the incidence of invasive S aureus infections among 468,201 infants (55.6% boys; median gestational age, 36 weeks) admitted to NICUs across the United States between 2016 and 2021.
infections among 468,201 infants (55.6% boys; median gestational age, 36 weeks) admitted to NICUs across the United States between 2016 and 2021. The primary outcome was late-onset invasive S aureus infection, defined as a positive culture result for S aureus from an abscess, blood, cerebrospinal fluid, peritoneum, or pleural fluid, collected at least 4 days after birth.
infection, defined as a positive culture result for from an abscess, blood, cerebrospinal fluid, peritoneum, or pleural fluid, collected at least 4 days after birth. Mortality attributed to S aureus infection was defined as the absolute difference in deaths occurring within 7 days of an invasive S aureus infection and deaths among matched infants without an S aureus infection.
TAKEAWAY:
Among infants with invasive infections, 80.9% were born at 32 weeks of gestation or earlier, 76.5% had VLBW, and 87.5% required central line placement during their NICU stay.
Infants with VLBW experienced nearly a 20-fold higher incidence of S aureus infection rates than infants with a birth weight ≥ 1500 g (227.1; 95% CI, 215.3-239.4 vs 10.1; 95% CI, 9.1-11.1 per 10,000 infants).
infection rates than infants with a birth weight ≥ 1500 g (227.1; 95% CI, 215.3-239.4 vs 10.1; 95% CI, 9.1-11.1 per 10,000 infants). Among infants with S aureus infections, all-cause mortality was substantially higher in infected infants (12.1% vs 1.0%), with VLBW infants accounting for 90.4% of deaths.
infections, all-cause mortality was substantially higher in infected infants (12.1% vs 1.0%), with VLBW infants accounting for 90.4% of deaths. The absolute difference in 7-day all-cause mortality between infants with S aureus infection occurring between postnatal days 4 and 28 and matched infants without infection was 5.3% (95% CI, 3.8-6.8).
IN PRACTICE:
'Late-onset invasive S aureus is an important contributor to disease burden in hospitalized infants, especially among infants with VLBW,' the study authors wrote.
'The lack of change in the incidence mediated by enhanced infection prevention measures suggests the need for novel strategies to further reduce the incidence and burden of S aureus infections,' wrote the study authors of the related editorial.
SOURCE:
The study was led by Aaron M. Milstone, MD, MHS, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore. It was published online on April 14, 2025, in JAMA Pediatrics .
LIMITATIONS:
The convenience sample may not have been representative of all hospitalized infants in US NICUs. Data were limited to infants during their admission to participating sites, potentially missing infections that occurred before admission or after transfer to another hospital. Additionally, the researchers were unable to explore differences in outcomes between methicillin-resistant and methicillin-sensitive S aureus infections.
DISCLOSURES:
The study received support from the Centers for Disease Control and Prevention and the National Institutes of Health. Three authors reported receiving consulting fees, grants, or honoraria from companies such as Tellus Therapeutics, Oak Hill Bio, Pediatrix, AbbVie, and Thermo Fisher Scientific PPD.
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