Abstract
Objective Coagulase-negative Staphylococcus (CoNS) is the most frequent pathogen causing late-onset sepsis (LOS) in neonatal
intensive care units (NICUs). Technical difficulties hinder blood culture (BC) collection
and obtaining only one culture before initiating antibiotic therapy is a common practice.
We sought to assess specific clinical information and CoNS cultures for the diagnosis
of true bacteremia in the NICU.
Study Design This historical cohort study was conducted in NICUs at the Hadassah-Hebrew University
Medical Center of Jerusalem in Israel. Clinical and laboratory data in every CoNS
bacteremia were collected and compared between bacteremia groups as follows: true
positive, two positive BCs; contaminant, one positive BC out of two; undefined, one
BC obtained and found positive.
Results For 3.5 years, CoNS was isolated in 139 episodes. True positive was identified in
44 of 139 (31.7%), contaminant in 42 of 139 (30.2%), and the event was undefined in
53 of 139 (38.1%). Vancomycin treatment was more frequent in the true positive and
undefined groups than the contaminant group (100, 90.6, and 73.8% respectively, p = 0.001); treatment was also prolonged in these two groups (p < 0.001). No clinical variables were associated with true bacteremia on multivariable
analysis.
Conclusion Diagnosis should definitely be based on at least two positive BCs, despite objective
difficulties in obtaining BCs in neonates.
Key Points
-
CoNS is a frequent pathogen causing LOS in neonates.
-
Due to technical difficulties, often only one culture is collected prior to antibiotic
therapy.
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No clinical/laboratory variables were associated with the diagnosis of true CoNS bacteremia.
Keywords
coagulase-negative
Staphylococcus
- bacteremia - sepsis
