Nosocomial septicemia and meningitis in neonates.

The past decade brought with it both highly sophisticated neonatal intensive care with improved perinatal mortality rates, and increased risk for nosocomial septicemia and meningitis among survivors. Although most of these infections were caused by multiple antibiotic-resistant gram negative enteric bacteria, Staphylococcus aureus "outbreaks" appeared sporadically. Risk for nosocomial infection was related primarily to factors which enhance infant contact with these bacteria (crowding and high nurse to infant ratios, poor handwashing practices, contaminated life support equipment, antibiotic exposure and prolonged hospitalization) in combination with those poorly defined determinants of bacterial virulence and host defense. Control measures for the prevention or reduction of these infections are aimed at decreasing the neonate's contact with the "outbreak" strains--improvement in handwashing practices and equipment sterilization processes, cohorting of infants, establishment of appropriate nurse:infant ratios, and in certain instances, modification of antibiotic practices. Future efforts should be directed toward better definition of bacterial virulence, host susceptibility and preventive measures.