Distinguishing true coagulase-negative Staphylococcus infections from contaminants in the neonatal intensive care unit

Healy, Catherine; Baker, Carol J.; Palazzi, Debra L.; Campbell, Judith R.; Edwards, Morven S.

doi:10.1038/jp.2012.36

Cited by 52 publications

(45 citation statements)

References 29 publications

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“…However, prematurity is also associated with longer hospital stay, more invasive iatrogenic procedures, including central line (CL), which are risk factors for CoNS sepsis. 32 Of all CL types, umbilical catheters were associated with higher BSI rates (rate ratio 2.4; 95% CI 1.2-4.9). 35 The number of venous CLs in place before the occurrence of sepsis was also identified as a risk factor for CoNS infection (odds ratio 3.5; 95% CI: 1.4-8.3 for each additional CL inserted).…”

Section: Discussionmentioning

confidence: 98%

“…35 The number of venous CLs in place before the occurrence of sepsis was also identified as a risk factor for CoNS infection (odds ratio 3.5; 95% CI: 1.4-8.3 for each additional CL inserted). 32 The contribution of CL dwell time to the risk of CoNS sepsis is not consistent across studies; a few suggested that longer dwell time was a risk factor. 35,36 In a retrospective study of 21 cases of BSI, the BSI incidence increased by 4% per day in the first 18 days after peripherally inserted central catheter (PICC) insertion (incidence rate ratio (IRR) 1.14; 95% CI: 1.04-1.25) and by 33% per day at 36 to 60 days after PICC insertion (IRR: 1.33; 95% CI: 1.12-1.57).…”

Section: Discussionmentioning

confidence: 98%

“…32,37,38 Therefore, CLs should be removed as soon as possible when they are no longer needed, but elective replacement of CL is not recommended as a preventive strategy. 32,37,39 Despite numerous epidemiologic studies reporting neonatal CoNS sepsis rates, the burden and trend of CoNS-related disease are difficult to assess, because of inconsistent definitions across studies (Box 1). A positive blood culture can reflect catheter or culture contamination rather than true infection, potentially leading to overestimation and high variability in CoNS sepsis rates.…”

Section: Discussionmentioning

confidence: 99%

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Staphylococcal Infections in Infants

Blanchard

Quach

Autmizguine

2015

Clinics in Perinatology

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Staphylococcal Infections in Infants

Blanchard

Quach

Autmizguine

2015

Clinics in Perinatology

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“…17 Six neonates (13.3%) had worsening of clinical condition in the form of poor activity, respiratory distress needing oxygen and poor peripheral circulation and positive CRP they needed treatment with vancomycin (4 CoNS) and meropenenem (2 contaminants other than CoNS). These 4 neonates with CoNS probably had true infection and their blood culture growth was true positive, while that of 2 neonate who had clinical sepsis, their blood culture with contaminants were false negatives due to insufficient blood volume or contamination of blood.…”

Section: Discussionmentioning

confidence: 99%

Blood contamination in neonates: clinicians' dilemma

Iyer

Naveen

et al. 2015

Int J Contemp Pediatr

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“…These criteria have often resulted in CONS being overrepresented as a true pathogen in neonatal sepsis (7). In an attempt to decrease falsepositivity rates, various investigators have proposed different diagnostic algorithms based upon quantitative culture and colony count, presence of an indwelling central venous catheter (8) or time to positivity of blood culture (9).…”

Section: Dear Editormentioning

confidence: 99%

Letter to the Editor: Prevalence and Antibiotic Resistance of Neonatal Sepsis Pathogens

Mandal

Sahi

2016

Arch Pediatr Infect Dis

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We read with great interest the original article by Behmadi et al. (1) in the most recent issue of your journal. We would like to commend the authors for their endeavor but at the same time feel that few necessary clarifications and comments would benefit the general readers of the journal:1) The abstract mentions that "the aim of this study was to determine the prevalence and evaluate the antimicrobial susceptibility patterns of bacterial infections at a neonatal unit," but the main text states that the objective was "to determine the frequency and antibiotic resistance of pathogens at the neonatal intensive-care unit (NICU) and neonatal ward of our hospital." The study, being "crosssectional" in design, is able to give prevalence but not frequency or incidence (2). Furthermore, the pathogens associated with neonatal sepsis include viruses and parasites, in addition to bacteria (3).2) The authors mention the total number of culture (blood, urine and cerebrospinal fluid (CSF)) samples and their positivity rates, but not the total number of newborns being assessed (sample size). Therefore, the percentage of newborns who ultimately have culture (blood, urine or CSF)-positive sepsis indicative of prevalence of bacterial infection, which is one of the study's primary objectives, can never be ascertained.3) The authors do not provide a definition for terms such as "late-onset sepsis" and "clinical findings suggesting urinary tract infection (UTI)." Different epidemiological studies have used cut-offs ranging from 3 to 7 days to define late-onset sepsis, depending on the gestational age and birth weight of the newborn (4). Also, there are no clinical findings that specifically suggest UTI in a newborn.4) The methodology does not state how the urine sample for bacterial culture was collected. It should ideally be collected by suprapubic aspiration (5); other methods are associated with high chances of contamination.5) The authors also do not mention whether hospitalacquired infections were included in the late-onset sepsis group. The causative organisms and the antibiotic sensitivity pattern are expected to vary considerably depending on whether the source of infection is the community or a heath care facility (5). Hospital-acquired pathogens could also explain the high prevalence of antibiotic resistance in the isolated organisms.6) The finding that coagulase-negative staphylococcus (CONS) was the commonest organism in both early-and late-onset sepsis should be viewed with caution in light of the great controversy about the criteria for defining CONS sepsis in newborns (6). These criteria have often resulted in CONS being overrepresented as a true pathogen in neonatal sepsis (7). In an attempt to decrease falsepositivity rates, various investigators have proposed different diagnostic algorithms based upon quantitative culture and colony count, presence of an indwelling central venous catheter (8) or time to positivity of blood culture (9).

show abstract

Distinguishing true coagulase-negative Staphylococcus infections from contaminants in the neonatal intensive care unit

Abstract: True CoNS infection is unlikely in infants with BW >2000 g and gestation >34 weeks. Total CL required for care, lethargy and gastric residuals predicted true CoNS infection.

Cited by 52 publications

References 29 publications

Staphylococcal Infections in Infants

Staphylococcal Infections in Infants

Blood contamination in neonates: clinicians' dilemma

Letter to the Editor: Prevalence and Antibiotic Resistance of Neonatal Sepsis Pathogens

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