Emergence of Coagulase Negative Staphylococci as Major Nosocomial Bloodstream Pathogens

Over an eight year period, 1975 to 1982, 1,843 nosocomial bloodstream infections were identified by routine prospective surveillance at the University of Virginia Hospital (106/10,000 admissions). Despite a decline in overall bloodstream infection rates during the study period (P = .085), bloodstream infections due to gram positive organisms increased from 29 (1975-1978) to 43/10,000 (1979-1982), (P less than 0.001). Notably, rates for coagulase negative staphylococci increased from 5.2 (1975-1978) to 12.4/10,000 (1979-1982), (P less than 0.001). In 1982, coagulase negative staphylococci accounted for 17% of all bloodstream infections and were the most frequently isolated pathogens. Sixty-four percent of patients with coagulase negative staphylococci were in critical care units versus 41% with other bloodstream infections (P less than .05). The recognition of coagulase negative staphylococci as significant bloodstream pathogens markedly alters the clinician's approach to nosocomial septicemia.