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Prevention and Treatment of Nosocomial Sepsis in the NICU

Journal of Perinatology volume 24, pages 446–453 (2004)Cite this article

Abstract

Nosocomial sepsis is a serious problem for neonates who are admitted for intensive care. It is associated with an increase in mortality, morbidity, and prolonged length of hospital stay. Thus, both the human and fiscal costs of these infections are high. Although the rate of nosocomial sepsis increases with the degree of both prematurity and low birth weight, no specific lab test has been shown to be very useful in improving our ability to predict who has a “real” blood-stream infection and, therefore, who needs to be treated with a full course of antibiotics. As a result, antibiotic use is double the rate of “proven” sepsis and we are facilitating the growth of resistant organisms in the neonatal intensive care unit. The purpose of this article is to describe simple changes in process, which when implemented, can reduce nosocomial infection rates in neonates and improve outcomes.

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References

  1. Adams-Chapman I, Stoll BJ . Prevention of nosocomial infections in the neonatal intensive care unit. Curr Opin Pediatr 2002;14(2):157–164.

    Article  PubMed  Google Scholar 

  2. Boyce JM, Rotter ML . Hospital hygiene procedures: areas of consensus and ongoing controversies. Proceedings of the 6th International BODE Hygiene Days 7–10 September 2000, Vienna, Austria. J Hosp Infect 2001;48(Suppl A): S1–S92.

    Article  PubMed  Google Scholar 

  3. Boyce JM . Consequences of inaction: importance of infection control practices. Clin Infect Dis 2001;33(Suppl 3):S133–S137.

    Article  PubMed  Google Scholar 

  4. Boyce JM . Antiseptic technology: access, affordability, and acceptance. Emerg Infect Dis 2001;7(2):231–233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Boyce JM . Using alcohol for hand antisepsis: dispelling old myths. Infect Control Hosp Epidemiol 2000;21(7):438–441.

    Article  CAS  PubMed  Google Scholar 

  6. Boyce JM . It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130(2):153–155.

    Article  CAS  PubMed  Google Scholar 

  7. Ehrenkranz NJ, Sanders CC, Eckert-Schollenberger D . et al. Lack of evidence of efficacy of cohorting nursing personnel in a neonatal intensive care unit to prevent contact spread of bacteria: an experimental study. Pediatr Infect Dis J 1992;11(2):105–113.

    Article  CAS  PubMed  Google Scholar 

  8. Ehrenkranz NJ . Bland soap handwash or hand antisepsis? The pressing need for clarity. Infect Control Hosp Epidemiol 1992;13(5):299–301.

    Article  CAS  PubMed  Google Scholar 

  9. Gould D . Infection control. Making sense of hand hygiene. Nurs Times 1994;90(30):63–64.

    CAS  PubMed  Google Scholar 

  10. Perraud M, Amazian K, Girard R, Tissot GF . The use of hand hygiene products could reduce colonization on the hands. J Hosp Infect 2001;47(4):336–337.

    Article  CAS  PubMed  Google Scholar 

  11. Handwashing agents. Infect Control 1987;8(9):384–385.

  12. Rahman M, Chattopadhyay B . Handwashing: unanswered questions and compliance. J Hosp Infect 2000;45(3):249–250.

    Article  CAS  PubMed  Google Scholar 

  13. CDC. Draft Guideline for Hand Hygiene in Healthcare Settings. CDC; 2002, Elsevier: England.

  14. Dharan S, Mourouga P, Copin P, Bessmer G, Tschanz B, Pittet D . Routine disinfection of patients' environmental surfaces. Myth or reality? J Hosp Infect 1999;42(2):113–117.

    Article  CAS  PubMed  Google Scholar 

  15. Ayliffe GA, Babb JR, Davies JG, Lilly HA . Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Infect 1988;11(3):226–243.

    Article  CAS  PubMed  Google Scholar 

  16. Kjolen H, Andersen BM . Handwashing and disinfection of heavily contaminated hands—effective or ineffective? J Hosp Infect 1992;21(1):61–71.

    Article  CAS  PubMed  Google Scholar 

  17. Larson E, Silberger M, Jakob K . et al. Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart Lung 2000;29(2):136–142.

    Article  CAS  PubMed  Google Scholar 

  18. Pittet D . Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48(Suppl A):S40–S46.

    Article  PubMed  Google Scholar 

  19. Pittet D . Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis 2001;7(2):234–240.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Pittet D . Promotion of hand hygiene: magic, hype, or scientific challenge? Infect Control Hosp Epidemiol 2002;23(3):118–119.

    Article  PubMed  Google Scholar 

  21. Boyce JM, Kelliher S, Vallande N . Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol 2000;21(7):442–448.

    Article  CAS  PubMed  Google Scholar 

  22. Doebbeling BN, Stanley GL, Sheetz CT et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327(2):88–93.

    Article  CAS  PubMed  Google Scholar 

  23. Larson EL, Laughon BE . Comparison of four antiseptic products containing chlorhexidine gluconate. Antimicrob Agents Chemother 1987;31(10):1572–1574.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Larson EL, Eke PI, Wilder MP, Laughon BE . Quantity of soap as a variable in handwashing. Infect Control 1987;8(9):371–375.

    Article  CAS  PubMed  Google Scholar 

  25. Hirschmann H, Fux L, Podusel J et al. The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications. J Hosp Infect 2001;49(3):199–203.

    Article  CAS  PubMed  Google Scholar 

  26. Hugonnet S, Perneger TV, Pittet D . Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 2002;162(9):1037–1043.

    Article  PubMed  Google Scholar 

  27. Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR . Hand washing frequency in an emergency department. Ann Emerg Med 1994;23(6):1307–1312.

    Article  CAS  PubMed  Google Scholar 

  28. Voss A, Widmer AF . No time for handwashing! Hand washing versus alcoholic rub: can we afford? 100% complaince? Infect Control Hosp Epidemiol 1997;18(3):205–208.

    Article  CAS  PubMed  Google Scholar 

  29. Muto CA, Sistrom MG, Farr BM . Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28(3):273–276.

    Article  CAS  PubMed  Google Scholar 

  30. Sharek PJ, Benitz WE, Abel NJ, Freeburn MJ, Mayer ML, Bergman DA . Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU. J Perinatol 2002;22(2):137–143.

    Article  PubMed  Google Scholar 

  31. Foca M, Jakob K, Whittier S et al. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343(10):695–700.

    Article  CAS  PubMed  Google Scholar 

  32. Moolenaar RL, Crutcher JM, San Joaquin VH et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21(2):80–85.

    Article  CAS  PubMed  Google Scholar 

  33. McNeil SA, Foster CL, Hedderwick SA, Kauffman CA . Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clin Infect Dis 2001;32(3):367–372.

    Article  CAS  PubMed  Google Scholar 

  34. Pottinger J, Burns S, Manske C . Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17(6):340–344.

    Article  CAS  PubMed  Google Scholar 

  35. Narayanan I, Prakash K, Gujral VV . The value of human milk in the prevention of infection in the high-risk low-birth-weight infant. J Pediatr 1981;99(3):496–498.

    Article  CAS  PubMed  Google Scholar 

  36. Hylander MA, Strobino DM, Dhanireddy R . Human milk feedings and infection among very low birth weight infants. Pediatrics 1998;102(3):E38.

    Article  CAS  PubMed  Google Scholar 

  37. Schanler RJ . The use of human milk for premature infants. Pediatr Clin North Am 2001;48(1):207–219.

    Article  CAS  PubMed  Google Scholar 

  38. Ohlsson A, Lacy JB . Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants. Cochrane Database Syst Rev 2001;(2):CD000361.

    Google Scholar 

  39. Jenson HB, Pollock BH . Meta-analyses of the effectiveness of intravenous immune globulin for prevention and treatment of neonatal sepsis. Pediatrics 1997;99(2):E2.

    Article  CAS  PubMed  Google Scholar 

  40. Ohlsson A, Lacy JB . Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev 2001;(2):CD001239.

    Google Scholar 

  41. American Institute of Architects. Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington, DC: The American Institute of Architects; 2001.

  42. O'Grady NP, Alexander M, Dellinger EP et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002;51(RR-10):1–29.

    PubMed  Google Scholar 

  43. Garland JS, Henrickson K, Maki DG . The 2002 Hospital Infection Control Practices Advisory Committee Centers for Disease Control and Prevention guideline for prevention of intravascular device-related infection. Pediatrics 2002;110(5):1009–1013.

    Article  PubMed  Google Scholar 

  44. Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG . A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis 1993;167(2):487–490.

    Article  CAS  PubMed  Google Scholar 

  45. Salzman MB, Rubin LG . Intravenous catheter-related infections. Adv Pediatr Infect Dis 1995;10:337–368.

    CAS  PubMed  Google Scholar 

  46. Sitges-Serra A, Hernandez R, Maestro S, Pi-Suner T, Garces JM, Segura M . Prevention of catheter sepsis: the hub. Nutrition 1997;13(4 Suppl):30S–35S.

    Article  CAS  PubMed  Google Scholar 

  47. Sitges-Serra A, Girvent M . Catheter-related bloodstream infections. World J Surg 1999;23(6):589–595.

    Article  CAS  PubMed  Google Scholar 

  48. Ng SP, Gomez JM, Lim SH, Ho NK . Reduction of nosocomial infection in a neonatal intensive care unit (NICU). Singapore Med J 1998;39(7):319–323.

    CAS  PubMed  Google Scholar 

  49. Salzman MB, Isenberg HD, Rubin LG . Use of disinfectants to reduce microbial contamination of hubs of vascular catheters. J Clin Microbiol 1993;31(3):475–479.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Segura M, Alia C, Oms L, Sancho JJ, Torres-Rodriguez JM, Sitges-Serra A . In vitro bacteriological study of a new hub model for intravascular catheters and infusion equipment. J Clin Microbiol 1989;27(12):2656–2659.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Segura M, Alia C, Valverde J, Franch G, Torres Rodriguez JM, Sitges-Serra A . Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis. J Clin Microbiol 1990;28(11):2551–2554.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Segura M, Alvarez-Lerma F, Tellado JM et al. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg 1996;223(4):363–369.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Garland JS, Alex CP, Mueller CD et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107(6):1431–1436.

    Article  CAS  PubMed  Google Scholar 

  54. Maki DG, Ringer M, Alvarado CJ . Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338(8763):339–343.

    Article  CAS  PubMed  Google Scholar 

  55. Raad II, Hohn DC, Gilbreath BJ et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15(4 Part 1):231–238.

    Article  CAS  PubMed  Google Scholar 

  56. Mermel LA, McCormick RD, Springman SR, Maki DG . The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan–Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91(3B):197S–205S.

    Article  CAS  PubMed  Google Scholar 

  57. Lopez Sastre JB, Coto CD, Fernandez CB . “Neonatal sepsis of nosocomial origin: an epidemiological study from the "Grupo de Hospitales Castrillo”. J Perinat Med 2002;30(2):149–157.

    Article  CAS  PubMed  Google Scholar 

  58. Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B . Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics 2002;109(1):34–39.

    Article  PubMed  Google Scholar 

  59. Nagata E, Brito AS, Matsuo T . Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 2002;30(1):26–31.

    Article  PubMed  Google Scholar 

  60. Chathas MK, Paton JB, Fisher DE . Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit. Am J Dis Child 1990;144(11):1246–1250.

    CAS  Google Scholar 

  61. Kennedy KA, Tyson JE, Chamnanvanikij S . Early versus delayed initiation of progressive enteral feedings for parenterally fed low birth weight or preterm infants. Cochrane Database Syst Rev 2000;(2):CD001970.

    Google Scholar 

  62. 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 Database Syst Rev 2000;(2):CD001241.

    Google Scholar 

  63. Craft AP, Finer NN, Barrington KJ . Vancomycin for prophylaxis against sepsis in preterm neonates. Cochrane Database Syst Rev 2000;(2):CD001971.

    Google Scholar 

  64. DeLisle S, Perl TM . Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest 2003;123(5 Suppl):504S–518S.

    Article  CAS  PubMed  Google Scholar 

  65. Lai KK, Fontecchio SA, Kelley AL, Baker S, Melvin ZS . The changing epidemiology of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2003;24(4):264–268.

    Article  PubMed  Google Scholar 

  66. Pierce CM, Wade A, Mok Q . Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 2000;26(7):967–972.

    Article  CAS  PubMed  Google Scholar 

  67. Jansen B, Ruiten D, Pulverer G . In-vitro activity of a catheter loaded with silver and teicoplanin to prevent bacterial and fungal colonization. J Hosp Infect 1995;31(3):238–241.

    Article  CAS  PubMed  Google Scholar 

  68. McCarthy A, Rao JS, Byrne M, Breatnach F, O'Meara CA . Central venous catheter infections treated with teicoplanin. Eur J Haematol Suppl 1998;62:15–17.

    CAS  PubMed  Google Scholar 

  69. Jansen B, Jansen S, Peters G, Pulverer G . In-vitro efficacy of a central venous catheter (‘Hydrocath’) loaded with teicoplanin to prevent bacterial colonization. J Hosp Infect 1992;22(2):93–107.

    Article  CAS  PubMed  Google Scholar 

  70. Kamal GD, Pfaller MA, Rempe LE, Jebson PJ . Reduced intravascular catheter infection by antibiotic bonding. A prospective, randomized, controlled trial. JAMA 1991;265(18):2364–2368.

    Article  CAS  PubMed  Google Scholar 

  71. Jansen B, Kristinsson KG, Jansen S, Peters G, Pulverer G . In-vitro efficacy of a central venous catheter complexed with iodine to prevent bacterial colonization. J Antimicrob Chemother 1992;30(2):135–139.

    Article  CAS  PubMed  Google Scholar 

  72. Kristinsson KG, Jansen B, Treitz U, Schumacher-Perdreau F, Peters G, Pulverer G . Antimicrobial activity of polymers coated with iodine-complexed polyvinylpyrrolidone. J Biomater Appl 1991;5(3):173–184.

    Article  CAS  PubMed  Google Scholar 

  73. Pai MP, Pendland SL, Danziger LH . Antimicrobial-coated/bonded and -impregnated intravascular catheters. Ann Pharmacother 2001;35(10):1255–1263.

    Article  CAS  PubMed  Google Scholar 

  74. Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD . Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999;281(3):261–267.

    Article  CAS  PubMed  Google Scholar 

  75. Elliott T . Intravascular catheter-related sepsis—novel methods of prevention. Intensive Care Med 2000;26(Suppl 1):S45–S50.

    Article  PubMed  Google Scholar 

  76. Hanley EM, Veeder A, Smith T, Drusano G, Currie E, Venezia RA . Evaluation of an antiseptic triple-lumen catheter in an intensive care unit. Crit Care Med 2000;28(2):366–370.

    Article  CAS  PubMed  Google Scholar 

  77. Darouiche RO, Raad II, Heard SO et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med 1999;340(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  78. Benjamin Jr. DK, Miller W, Garges H et al. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001;107(6):1272–1276.

    Article  PubMed  Google Scholar 

  79. Nazemi KJ, Buescher ES, Kelly Jr. RE, Karlowicz MG . Central venous catheter removal versus in situ treatment in neonates with enterobacteriaceae bacteremia. Pediatrics 2003;111(3):e269–e274.

    Article  PubMed  Google Scholar 

  80. Karlowicz MG, Furigay PJ, Croitoru DP, Buescher ES . Central venous catheter removal versus in situ treatment in neonates with coagulase-negative staphylococcal bacteremia. Pediatr Infect Dis J 2002;21(1):22–27.

    Article  PubMed  Google Scholar 

  81. Chapman RL, Faix RG . Persistent bacteremia and outcome in late onset infection among infants in a neonatal intensive care unit. Pediatr Infect Dis J 2003;22(1):17–21.

    Article  PubMed  Google Scholar 

  82. Bloom BT, Craddock A, Delmore PM et al. Reducing acquired infections in the NICU: observing and implementing meaningful differences in process between high and low acquired infection rate centers. J Perinatol 2003;23(6):489–492.

    Article  PubMed  Google Scholar 

  83. Long MN, Wickstrom G, Grimes A, Benton CF, Belcher B, Stamm AM . Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 1996;17(1):14–19.

    Article  CAS  PubMed  Google Scholar 

  84. Cordero L, Sananes M, Ayers LW . Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol 2000;20(3):151–156.

    Article  CAS  PubMed  Google Scholar 

  85. Deppe SA, Kelly JW, Thoi LL et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med 1990;18(12):1389–1393.

    Article  CAS  PubMed  Google Scholar 

  86. Tan SG, Lim SH, Malathi I . Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience. Int J Nurs Pract 1995;1(1):52–58.

    Article  CAS  PubMed  Google Scholar 

  87. Donowitz LG . Failure of the overgown to prevent nosocomial infection in a pediatric intensive care unit. Pediatrics 1986;77(1):35–38.

    Article  CAS  PubMed  Google Scholar 

  88. Pelke S, Ching D, Easa D, Melish ME . Gowning does not affect colonization or infection rates in a neonatal intensive care unit. Arch Pediatr Adolesc Med 1994;148(10):1016–1020.

    Article  CAS  PubMed  Google Scholar 

  89. Krediet TG, Beurskens FJ, van Dijk H, Gerards LJ, Fleer A . Antibody responses and opsonic activity in sera of preterm neonates with coagulase-negative staphylococcal septicemia and the effect of the administration of fresh frozen plasma. Pediatr Res 1998;43(5):645–651.

    Article  CAS  PubMed  Google Scholar 

  90. Burgner D . Fresh frozen plasma and neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 1994;71(3):F233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Acunas BA, Peakman M, Liossis G et al. Effect of fresh frozen plasma and gammaglobulin on humoral immunity in neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 1994;70(3):F182–F187.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Campbell JR, Zaccaria E, Baker CJ . Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: a case-control study. Pediatrics 2000;105(5):1041–1045.

    Article  CAS  PubMed  Google Scholar 

  93. Lund C, Kuller J, Lane A, Lott JW, Raines DA . Neonatal skin care: the scientific basis for practice. Neonatal Netw 1999;18(4):15–27.

    Article  CAS  PubMed  Google Scholar 

  94. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA . Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2001;30(1):41–51.

    Article  CAS  PubMed  Google Scholar 

  95. Lund CH, Kuller J, Lane AT, Lott JW, Raines DA, Thomas KK . Neonatal skin care: evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices. Association of Women's Health, Obstetric and Neonatal Nurses/National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2001;30(1):30–40.

    Article  CAS  PubMed  Google Scholar 

  96. Janota J, Stranak Z, Belohlavkova S . Interleukin-6, procalcitonin, C-reactive protein and the immature to total neutrophil ratio (I/T) in the diagnosis of early-onset sepsis in low birth weight neonates. Ceska Gynekol 2000;65(Suppl 1):29–33.

    PubMed  Google Scholar 

  97. Magudumana MO, Ballot DE, Cooper PA et al. Serial interleukin 6 measurements in the early diagnosis of neonatal sepsis. J Trop Pediatr 2000;46(5):267–271.

    Article  CAS  PubMed  Google Scholar 

  98. Mehr S, Doyle L . Interleukin-6 concentrations in neonatal sepsis. Lancet 1999;353(9166):1798–1799.

    Article  CAS  PubMed  Google Scholar 

  99. Yilmaz E, Gurgoze MK, Ilhan N, Dogan Y, Aydinoglu H . Interleukin-8 levels in children with bacterial, tuberculous and aseptic meningitis. Indian J Pediatr 2002;69(3):219–221.

    Article  PubMed  Google Scholar 

  100. Sikora JP, Chlebna-Sokol D, Krzyzanska-Oberbek A . Proinflammatory cytokines (IL-6, IL-8), cytokine inhibitors (IL-6sR, sTNFRII) and anti-inflammatory cytokines (IL-10, IL-13) in the pathogenesis of sepsis in newborns and infants. Arch Immunol Ther Exp (Warsz) 2001;49(5):399–404.

    CAS  Google Scholar 

  101. Schollin J . Interleukin-8 in neonatal sepsis. Acta Paediatr 2001;90(9):961–962.

    Article  CAS  PubMed  Google Scholar 

  102. Mehr SS, Doyle LW, Rice GE, Vervaart P, Henschke P . Interleukin-6 and interleukin-8 in newborn bacterial infection. Am J Perinatol 2001;18(6):313–324.

    Article  CAS  PubMed  Google Scholar 

  103. Martin H, Olander B, Norman M . Reactive hyperemia and interleukin 6, interleukin 8, and tumor necrosis factor-alpha in the diagnosis of early-onset neonatal sepsis. Pediatrics 2001;108(4):E61.

    Article  CAS  PubMed  Google Scholar 

  104. Franz AR, Steinbach G, Kron M, Pohlandt F . Interleukin-8: a valuable tool to restrict antibiotic therapy in newborn infants. Acta Paediatr 2001;90(9):1025–1032.

    Article  CAS  PubMed  Google Scholar 

  105. Franz AR, Steinbach G, Kron M, Pohlandt F . Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 1999;104(3 Part 1):447–453.

    Article  CAS  PubMed  Google Scholar 

  106. Franz AR, Kron M, Pohlandt F, Steinbach G . Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants. Pediatr Infect Dis J 1999;18(8):666–671.

    Article  CAS  PubMed  Google Scholar 

  107. Enguix A, Rey C, Concha A, Medina A, Coto D, Dieguez MA . Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive Care Med 2001;27(1):211–215.

    Article  CAS  PubMed  Google Scholar 

  108. Ronnestad A, Abrahamsen TG, Gaustad P, Finne PH . C-reactive protein (CRP) response patterns in neonatal septicaemia. APMIS 1999;107(6):593–600.

    Article  CAS  PubMed  Google Scholar 

  109. Benitz WE, Han MY, Madan A, Ramachandra P . Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998;102(4):E41.

    Article  CAS  PubMed  Google Scholar 

  110. Pourcyrous M, Bada HS, Korones SB, Baselski V, Wong SP . Significance of serial C-reactive protein responses in neonatal infection and other disorders. Pediatrics 1993;92(3):431–435.

    Article  CAS  PubMed  Google Scholar 

  111. Ang AT, Ho NK, Chia SE . The usefulness of CRP and I/T ratio in early diagnosis of infections in Asian newborns. J Singapore Paediatr Soc 1990;32(3–4):159–163.

    CAS  PubMed  Google Scholar 

  112. Seibert K, Yu VY, Doery JC, Embury D . The value of C-reactive protein measurement in the diagnosis of neonatal infection. J Paediatr Child Health 1990;26(5):267–270.

    Article  CAS  PubMed  Google Scholar 

  113. de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN . An antibiotic policy to prevent emergence of resistant bacilli. Lancet 2000;355(9208):973–978.

    Article  CAS  PubMed  Google Scholar 

  114. Sinkowitz RL, Keyserling H, Walker TJ, Holland J, Jarvis WR . Epidemiology of vancomycin usage at a children's hospital, 1993 through 1995. Pediatr Infect Dis J 1997;16(5):485–489.

    Article  CAS  PubMed  Google Scholar 

  115. Stoll BJ, Hansen N, Fanaroff AA et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2 Part 1):285–291.

    Article  PubMed  Google Scholar 

  116. Karlowicz MG, Buescher ES, Surka AE . Fulminant late-onset sepsis in a neonatal intensive care unit, 1988-1997, and the impact of avoiding empiric vancomycin therapy. Pediatrics 2000;106(6):1387–1390.

    Article  CAS  PubMed  Google Scholar 

  117. Benjamin Jr. DK, Ross K, McKinney Jr. RE, Benjamin DK, Auten R, Fisher RG . When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000;106(4):712–718.

    Article  PubMed  Google Scholar 

  118. Garcia-Prats JA, Cooper TR, Schneider VF, Stager CE, Hansen TN . Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics 2000;105(3 Part 1):523–527.

    Article  CAS  PubMed  Google Scholar 

  119. Kumar Y, Qunibi M, Neal TJ, Yoxall CW . Time to positivity of neonatal blood cultures. Arch Dis Child Fetal Neonatal Ed 2001;85(3):F182–F186.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Kaiser JR, Cassat JE, Lewno MJ . Should antibiotics be discontinued at 48 hours for negative late-onset sepsis evaluations in the neonatal intensive care unit? J Perinatol 2002;22(6):445–447.

    Article  PubMed  Google Scholar 

  121. Kurlat I, Stoll BJ, McGowan Jr. JE . Time to positivity for detection of bacteremia in neonates. J Clin Microbiol 1989;27(5):1068–1071.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  122. Pauli Jr. I, Shekhawat P, Kehl S, Sasidharan P . Early detection of bacteremia in the neonatal intensive care unit using the new BACTEC system. J Perinatol 1999;19(2):127–131.

    Article  PubMed  Google Scholar 

  123. Pichichero ME, Todd JK . Detection of neonatal bacteremia. J Pediatr 1979;94(6):958–960.

    Article  CAS  PubMed  Google Scholar 

  124. Hertz D, Fuller D, Davis T, Papile L, Stevenson D, Lemons J . Comparison of DNA probe technology and automated continuous-monitoring blood culture systems in the detection of neonatal bacteremia. J Perinatol 1999;19(4):290–293.

    Article  CAS  PubMed  Google Scholar 

  125. Rowley AH, Wald ER . Incubation period necessary to detect bacteremia in neonates. Pediatr Infect Dis 1986;5(5):590–591.

    Article  CAS  PubMed  Google Scholar 

  126. Kicklighter SD . Antifungal agents and fungal prophylaxis in the neonate. NeoReviews 2002;3(12):249e–2255.

    Article  Google Scholar 

  127. Hudome SM, Fisher MC . Nosocomial infections in the neonatal intensive care unit. Curr Opin Infect Dis 2001;14(3):303–307.

    Article  CAS  PubMed  Google Scholar 

  128. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG . Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 2001;345(23):1660–1666.

    Article  CAS  PubMed  Google Scholar 

  129. Kicklighter SD, Springer SC, Cox T, Hulsey TC, Turner RB . Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001;107(2):293–298.

    Article  CAS  PubMed  Google Scholar 

  130. Hurley R, Winner HI . Experimental moniliasis in the mouse. J Pathol Bacteriol 1963;86:75–81.

    Article  CAS  PubMed  Google Scholar 

  131. Hurley R . The pathogenicity of Candida stellatoidea. J Pathol Bacteriol 1965;90(1):351–354.

    Article  CAS  PubMed  Google Scholar 

  132. Beno DW, Mathews HL . Quantitative measurement of lymphocyte mediated growth inhibition of Candida albicans. J Immunol Methods 1993;164(2):155–164.

    Article  CAS  PubMed  Google Scholar 

  133. Rex JH, Walsh TJ, Anaissie EJ . Fungal infections in iatrogenically compromised hosts. Adv Intern Med 1998;43:321–371.

    CAS  PubMed  Google Scholar 

  134. Hughes WT . Systemic candidiasis: a study of 109 fatal cases. Pediatr Infect Dis 1982;1(1):11–18.

    Article  CAS  PubMed  Google Scholar 

  135. Telenti A, Roberts GD . Fungal blood cultures. Eur J Clin Microbiol Infect Dis 1989;8(9):825–831.

    Article  CAS  PubMed  Google Scholar 

  136. Berenguer J, Buck M, Witebsky F, Stock F, Pizzo PA, Walsh TJ . Lysis–centrifugation blood cultures in the detection of tissue-proven invasive candidiasis. Disseminated versus single-organ infection. Diagn Microbiol Infect Dis 1993;17(2):103–109.

    Article  CAS  PubMed  Google Scholar 

  137. Benjamin Jr. DK, Miller WC, Bayliff S, Martel L, Alexander KA, Martin PL . Infections diagnosed in the first year after pediatric stem cell transplantation. Pediatr Infect Dis J 2002;21(3):227–234.

    Article  PubMed  Google Scholar 

  138. Leibovitz E . Neonatal candidosis: clinical picture, management controversies and consensus, and new therapeutic options. J Antimicrob Chemother 2002;49(Suppl 1):69–73.

    Article  CAS  PubMed  Google Scholar 

  139. Rex JH, Walsh TJ, Sobel JD et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000;30(4):662–678.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Pediatrix Medical Group, Inc., (R.C.), Sunrise, FL, USA

    Reese Clark MD

  2. Duke University Medical Center, (R.C., D.K.B.), Durham, NC, USA

    Reese Clark MD & Daniel K Benjamin Jr MD, MPH, PhD

  3. Children's Mercy Hospital, (R.P.), Oakland, CA, USA

    Richard Powers MD

  4. Memorial Hospital of South Bend, (R.W.), South Bend, ID, USA

    Robert White MD

  5. Wesley Medical Center, (B.B.), Wichita, KS, USA

    Barry Bloom MD

  6. University of Texas Southwestern Medical Center, (P.S), Dallas, TX, USA

    Pablo Sanchez MD

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  1. Reese Clark MD
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  2. Richard Powers MD
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  3. Robert White MD
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  6. Daniel K Benjamin Jr MD, MPH, PhD
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Clark, R., Powers, R., White, R. et al. Prevention and Treatment of Nosocomial Sepsis in the NICU. J Perinatol 24, 446–453 (2004). https://doi.org/10.1038/sj.jp.7211125

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