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Nosocomial Coagulase Negative Staphylococcal (CoNS) Catheter-Related Sepsis in Preterm Infants: Definition, Diagnosis, Prophylaxis, and Prevention

Journal of Perinatology volume 21, pages 186–192 (2001)Cite this article

Abstract

Nosocomial infections with coagulase negative staphylococcus (CoNS) are a frequent and significant cause of morbidity in the preterm infant. Infections diagnosed after the first 72 hours of life are arbitrarily deemed to be “nosocomial.” There are many difficulties encountered in efforts to evaluate and compare nosocomial sepsis in the NICU. An issue of primary concern is the lack of uniformity in the definition of sepsis in the NICU. Based on the frequency of positive blood cultures in infants less than 1000 g, it appears reasonable to evaluate methods for the prevention of nosocomial sepsis. These include prophylactic antibiotic administration, antiseptic impregnated catheters, and the use of an antibiotic lock technique.

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References

  1. Drossou V, Kanakoudi F, Tzimouli V, et al Impact of prematurity, stress and sepsis on neutrophil respiratory burst activity of neonates Biol Neonate 1997 72 201–9

    Article  CAS  Google Scholar 

  2. Kallman J, Schollin J, Schalen C, Erlandsson A, Kihlstrom E Impaired phagocytosis and opsonization towards group B streptococci in preterm neonates Arch Dis Child Fetal Neonat Ed 1998 78 F46–50

    Article  CAS  Google Scholar 

  3. Ballow M, Cates KL, et al Development of the immune system in very low birth weight (less than 1500 g) premature infants: concentrations of plasma immunoglobulins and patterns of infections Pediatr Res 1986 20 899–904

    Article  CAS  Google Scholar 

  4. Rutter N The immature skin Eur J Pediatr 1996 155 (Suppl 2) S18–20

    Article  Google Scholar 

  5. Insoft RM, Sanderson IR, Walker WA Development of immune function in the intestine and its role in neonatal diseases Pediatr Clin North Am 1996 43 551–71

    Article  CAS  Google Scholar 

  6. Johnson-Robbins LA, El-Mohandes AE, Simmens SJ Staphylococcus epidermidis sepsis in the intensive care nursery: a characterization of risk associations in infants <1000 g Biol Neonate 1996 69 249–56

    Article  CAS  Google Scholar 

  7. Nataro JP, Corcoran L, Zirin S, et al Prospective analysis of coagulase negative staphylococcal infection in hospitalized infants J Pediatr 1994 125 798–804

    Article  CAS  Google Scholar 

  8. Freeman J, Goldmann DA, Smith NE, Sidebottom DG, Epstein MF, Platt R Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units N Engl J Med 1990 Aug 2 323 (5) 301–8

    Article  CAS  Google Scholar 

  9. Avila-Figueroa C, Goldmann DA, Richardson DK, Gray JE, Ferrari A, Freeman J Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns Pediatrics 1998 Jan 17 (1) 10–7

    CAS  Google Scholar 

  10. Patrick CC Coagulase negative staphylococci: pathogens with increasing clinical significance J Pediatr 1990 116 497

    Article  CAS  Google Scholar 

  11. Ronnestad A, Abrahamsen TG, Gaustad P, Finne PH Blood culture isolates during 6 years in a tertiary neonatal intensive care unit Scand J Infect Dis 1998 30 (3) 245–51

    Article  CAS  Google Scholar 

  12. Vermont CL, Hartwig NG, Fleer A, et al Persistence of clones of coagulase-negative staphylococci among premature neonates in neonatal intensive care units: two-center study of bacterial genotyping and patient risk factors J Clin Microbiol 1998 Sep 36 (9) 2485–90

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Kallman J, Kihlstrom E, Sjoberg L, Schollin J Increase of staphylococci in neonatal septicaemia: a fourteen-year study Acta Paediatr 1997 May 86 (5) 533–38

    Article  CAS  Google Scholar 

  14. Gaynes RP, Horan TC Definitions of nosocomial infections In: Mayhall CG, editor. Hospital Epidemiology and Infection Control Baltimore, MD: Williams and Wilkins 1995 chap. 77, A1

  15. Stoll BJ, Gordon T, Korones SB, et al Late onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network J Pediatr 1996 129 63–71

    Article  CAS  Google Scholar 

  16. Horbar JD, Lucey JF, Soll RF, et al Vermont Oxford Network Database Manual of Operations, Release 3.3; 1997 p.19

  17. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis Crit Care Med 1992 20 864–74

  18. Schelonka RL, et al Volume of blood required to detect common neonatal pathogens J Pediatr 1996 129 275–8

    Article  CAS  Google Scholar 

  19. Rowley AH, Wald ER Incubation period necessary to detect bacteremia in neonates Pediatr Infect Dis 1986 5 590–1

    Article  CAS  Google Scholar 

  20. Atela I, Coll P, Rello J, et al Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research J Clin Microbiol 1997 35 1784–90

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Blot F, Nitenberg E, et al Diagnosis of catheter related bacteremia: a prospective comparison of the time to positivity of hub blood versus peripheral blood cultures Lancet 1999 354 1071–77

    Article  CAS  Google Scholar 

  22. St Geme JW, Bell LM, Baumgart S, et al Distinguishing sepsis from blood culture contamination in young infants with blood cultures growing coagulase negative staphylococci Pediatrics 1990 86 157–62

    PubMed  Google Scholar 

  23. Ruderman JW, Morgan MA, Klein AH Quantitative blood cultures in the diagnosis of sepsis in infants with umbilical and Broviac catheters J Pediatr 1988 122 748–51

    Article  Google Scholar 

  24. Kite P, Millar MR, Gorham P, Congdon P Comparison of five tests used in diagnosis of neonatal bacteraemia Arch Dis Child 1988 63 639–43

    Article  CAS  Google Scholar 

  25. Modanlou H, Ortiz OB Thrombocytopenia in neonatal infection Clin Pediatr (Philadelphia) 1981 20 402–7

    Article  CAS  Google Scholar 

  26. Patrick CH, Lazarchick J The effect of bacteremia on automated platelet measurements in neonates Am J Clin Pathol 1990 93 391–4

    Article  CAS  Google Scholar 

  27. Ng PC, Cheng SH, Chui KM, et al Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birth weight infants Arch Dis Child 1997 77 F221–7

    Article  CAS  Google Scholar 

  28. Moller JC, Nelskamp I, Jensen R, et al Comparison of vancomycin and teicoplanin for prophylaxis of sepsis with coagulase negative staphylococci in very low birth weight infants J Perinat Med 1997 25 361–7

    Article  CAS  Google Scholar 

  29. Matrai-Kovalkis Y, Greenberg D, Shinwell ES, Fraser D, Dagan R Positive blood cultures for coagulase negative staphylococci in neonates: does highly selective vancomycin usage affect outcome? Infection 1998 26 85–92

    Article  Google Scholar 

  30. Raad II, Hohn DC, Gilbreath J, et al Prevention of central venous catheter related infections by using maximal sterile barrier precautions during insertion Infect Control Hosp Epidemiol 1994 15 231–8

    Article  CAS  Google Scholar 

  31. Pacifici A, Manieri R, De Medici M Total parenteral nutrition: a study of the microbial contamination of the bags and the infusion lines Ann Ital Chir 1992 63 89–91

    CAS  PubMed  Google Scholar 

  32. Baier RJ, Bocchini JA, Brown EG Selective use of vancomycin to prevent coagulase negative staphylococcal nosocomial bacteremia in high risk very low birth weight infants Pediatr Infect Dis J 1998 17 179–83

    Article  CAS  Google Scholar 

  33. Kacica MA, Horgan, MJ, Ochoa L, Sandler R, Lepow ML, Venezia RA Prevention of gram positive sepsis in neonates weighing less than 1500 grams J Pediatr 1994 125 253–8

    Article  CAS  Google Scholar 

  34. Spafford PS, Sinkin RA, Cox C, Reubens L, Powell KR Prevention of central venous catheter related coagulase negative staphylococcal sepsis in neonates J Pediatr 1994 125 259–63

    Article  CAS  Google Scholar 

  35. Cooke RWI, Nycyk JA, Okuonghuae H, Shah V, Damjanovic V, Hart CA Low dose vancomycin prophylaxis reduces coagulase negative staphylococcal bacteremia in very low birthweight infants J Hosp Infect 1997 37 297–303

    Article  CAS  Google Scholar 

  36. Moller JC, Rossa M, Nachtrodt G, Richter A, Tegtmeyer FK Praventive antibiotikagabe zur verhinderung nosokomialer septikamien bei sehr kleinen fruhgeborenen (VLBW infants) Klin Paediatr 1993 205 140–4

    Article  CAS  Google Scholar 

  37. Craft AP, Finer NN, Barrington KJ Vancomycin for prophylaxis against sepsis in preterm neonates (Cochrane Review) In: The Cochrane Library, Issue 1. Oxford: Update Software 2000

  38. Maki DG, Stoltz SM, Wheeler S, Mermel LA Prevention of central venous catheter related bloodstream infection by use of an antiseptic impregnated catheter Ann Intern Med 1997 127 257–66

    Article  CAS  Google Scholar 

  39. Raad I, Darouiche R, Dupuis J, et al Central venous catheters coated with minocycline and rifampin for the prevention of catheter related colonization and bloodstream infections Ann Surg 1996 223 363–9

    Article  Google Scholar 

  40. Schwartz C, Henrickson KJ, Roghmann K, Powell K Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin susceptible organisms J Clin Oncol 1990 8 1591–7

    Article  CAS  Google Scholar 

  41. Carratala J, Niubo J, Fernandez-Sevilla A, et al Randomized double blind trial of an antibiotic lock technique for prevention of gram positive central venous catheter related infection in neutropenic patients with cancer Antimicrob Agents Chemother 1999 43 2200–4

    Article  CAS  Google Scholar 

  42. Henrickson KJ, Axtell RA, Hoover SM, et al Prevention of central venous catheter related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial J Clin Oncol 2000 18 1269–78

    Article  CAS  Google Scholar 

  43. Rayyis SF, Ambalavanan N, Wright L, Carlo WA Randomized trial of “slow” versus “fast” feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants J Pediatr 1999 134 293–7

    Article  CAS  Google Scholar 

  44. Book LS, Herbst JJ, Jung AL Comparison of fast- and slow-feeding rate schedules to the development of NEC J Pediatr 1976 89 463–6

    Article  CAS  Google Scholar 

  45. Caple, JI, Armentrout DC, Huseby VD, Halbrdier BM, Garcia J, Sparks JW The effect of feeding volume on clinical outcome of premature infants Pediatr Res 1997 41 229A

    Article  Google Scholar 

  46. Anderson DM, Kliegman RM The relationship of neonatal alimentation practices to the occurence of endemic necrotizing enterocolitis Am J Perinatol 1991 8 62–7

    Article  CAS  Google Scholar 

  47. McKeown RE, Marsh TD, Amarnath U, Garrison CZ, Addy CL, Thompson SJ Role of delayed feeding and of feeding increments in necrotizing enterocolitis J Pediatr 1992 121 764–70

    Article  CAS  Google Scholar 

  48. Goldman HI Feeding and NEC Am J Dis Child 1980 134 553–5

    CAS  PubMed  Google Scholar 

  49. LaGamma EF, Browne LE Feeding practices for infants weighing less than 1500 grams at birth and the pathogenesis of necrotizing enterocolitis Clin Perinatol 1994 21 271–306

    Article  CAS  Google Scholar 

  50. Kennedy KA, Tyson JE, Chamnanvanakij S Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants (Cochrane Review) In: The Cochrane Library, Issue 2. Oxford: Update Software 2000

  51. Kennedy KA, Tyson JE, Chamnanvanakij S Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants (Cochrane Review) In: The Cochrane Library, Issue 2. Oxford: Update Software 2000

  52. Doebbeling BN, Stanley GL, Sheetz CT, et al Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units N Engl J Med 1992 327 88–93

    Article  CAS  Google Scholar 

  53. Agee KR, Balk RA Central venous catheterization in the critically ill patient Crit Care Clin 1992 8 677–86

    Article  CAS  Google Scholar 

  54. Cordero L, Sananes M, Ayers LW Failure of systemic antibiotics to eradicate gram negative bacilli from the airway of mechanically ventilated very low birthweight infants Am J Infect Control 2000 28 286–90

    Article  CAS  Google Scholar 

  55. Tuttle D, Leef K, Moore G, et al Increased risk of line sepsis associated with peripherally inserted central venous catheters in premature infants Pediatr Res 2000 47 279A

    Google Scholar 

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  1. Neonatal Specialists, Ltd., Phoenix, AZ

    Alissa Craft DO & Neil Finer MD

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  2. Neil Finer MD
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Craft, A., Finer, N. Nosocomial Coagulase Negative Staphylococcal (CoNS) Catheter-Related Sepsis in Preterm Infants: Definition, Diagnosis, Prophylaxis, and Prevention. J Perinatol 21, 186–192 (2001). https://doi.org/10.1038/sj.jp.7200514

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