American Journal of Epidemiology Vol. 132, No. 6: 1130-1140
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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BIRTH WEIGHT AND LENGTH OF STAY AS DETERMINANTS OF NOSOCOMIAL COAGULASE-NEGATIVE STAPHYLOCOCCAL BACTEREMIA IN NEONATAL INTENSIVE CARE UNIT POPULATIONS: POTENTIAL FOR CONFOUNDING
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA
2Brockton/West Rozbury Veterans Administration Medical Center, Harvard Medical School Boston, MA
3Department of Epidemiology, Harvard University School of Public Health Boston, MA
4Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, MA
5Department of Newborn Medicine, Children's Hospital, Harvard Medical School Boston, MA
6Division of Infectious Diseases, and the Infection
Coagulase-negative staphylococci are the most common cause of bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and the Children's Hospital, Boston, Massachusetts. In 1982, nosocomial bacteremia with coagulase-negative staphylococci occurred in 45 of 882 (5.1%) infants admitted to these units who survived and remained in intensive care for more than 48 hours and were therefore at risk. The overall cumulative incidence (attack rate) of nosocomial bacteremia rose dramatically with decreasing birth weight. The smallest infants, those with birth weights of less than 750g, experienced an overall risk of nosocomial bacteremia 44.5 times that of infants with birth weights of greater than 2,000g. A large part of the excess risk for small babies was attributable to their longer hospitalizations. However, after adjustment for length of stay, the smallest infants still suffered a daily rate of bacteremia (incidence density) 5.3 times that of the largest, indicating a considerable residual effect of birth weight on the daily risk of nosocornial coagulase-negative staphylococcal bacteremia. The results were similar in the two nurseries. Thus, there is still a substantially increased intrinsic risk of nosocomial coagulase-negative staphy iococcal bacteremia among infants with very low birth weights, even after adjustment for duration of hospitalization, and differences in birth weight can confound comparative studies.
confounding factors (epidemiology); disease outbreaks; Infant, low birth weight; infant, newborn; intensive care units, neonatal; length of stay; septicemia; staphylococcal infections
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