Coagulase-Negative Staphylococcal Infections in the Neonate and Child: An Update
Section snippets
CONS Species
Thirty-eight species of CONS have been recognized, and 13 of them are known to colonize humans (see ftp://ftp.cict.fr/pub/bacterio/). Novobiocin susceptibility is useful in differentiating CONS species into two groups. The novobiocin-resistant strains include Staphyloccocus saprophyticus and Staphyloccocus xylosus, with the former being well known to cause urinary tract infections in immune-competent women.7 Novobiocin-susceptible strains include Staphyloccocus epidermidis, Staphyloccocus
Pathogenicity and Virulence
Most research into virulence factors, specifically those involved in adhesion, aggregation, and biofilm (slime) formation, has been conducted with S. epidermidis.
Diagnosis
Establishing the diagnosis of CONS sepsis or infection can be complex, and difficulty exists in differentiating infection from contamination. CONS is a commensal and can contaminate cultures. This contamination may occur either at the time of blood sampling or during the blood culture process. Different definitions exist for the diagnosis of a true CONS sepsis. The most commonly used neonatal definitions for CONS infection involve one positive culture with clinical signs or symptoms of
Antibiotics
Antibiotics are the mainstay in the treatment of CONS infections. Penicillinase-resistant penicillins (eg, nafcillin or oxacillin) are not the drugs of choice in view of the high rates of methicillin resistance, ranging from 70 to 92 percent.45 Therefore, glycopeptides such as vancomycin are the first choice for treatment of CONS infections.46 Teicoplanin is another glycopeptide (not available in the United States) that has several advantages (it can be given intravenously or intramuscularly,
Catheter Dressing
Avoiding the use of CVCs, use of closed medication systems, and limiting access to central lines reduces the incidence of sepsis significantly.71 The value of using a disinfectant impregnated dressing of the CVC has been evaluated in a large randomized controlled trial, in which 705 neonates were randomized to (1) Povidone-iodine (10%) scrub before line insertion or (2) alcohol (70%) scrub followed by a chlorhexidine impregnated disk over the catheter insertion site. Antimicrobial dressing
Adjuvant Treatments
Several adjuvant treatments have been evaluated in neonatal sepsis in general but not specifically in CONS sepsis. Granulocyte transfusions used for treatment in neonates with sepsis and neutropenia77and granulocyte colony stimulating factor and granulocyte-macrophage colony stimulating factor used to treat or prevent sepsis in neonates did not reduce the rate of mortality.78 Pentoxifylline, a xanthine derivative that inhibits the release of tumor necrosis factor-α, has been shown to reduce
Infection Control
Epidemiological investigations during outbreaks are important in delineating the source of infection and in interrupting transmission. Conventional techniques (biotyping, antibiograms, serotyping etc.) have been supplanted by molecular techniques (PCR, gel electrophoresis). Molecular epidemiological tools may be useful for recognizing patterns of transmission, identifying sources of infection, and assessing the effect of interventions.92 Using molecular techniques (pulsed-field gel
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Cited by (80)
Antibiotic Stewardship
2018, Infectious Disease and Pharmacology: Neonatology Questions and ControversiesHospital-wide comparison of health care-associated infection among 8 intensive care units: A retrospective analysis for 2010-2015
2017, American Journal of Infection ControlSerum levels of vancomycin: is there a prediction using doses in mg/kg/day or m<sup>2</sup>/day for neonates?
2016, Brazilian Journal of Infectious DiseasesCitation Excerpt :However, empirical dose of vancomycin is not ideal according to inappropriate serum levels of the drug that have been reported in neonates in several studies.5,9,10,12,13 Although there have been previous descriptions of dose calculations based on nomograms and adjustments according to drug clearance and the patient's renal function,5,14–17 no study has analyzed doses that were prescribed according to body surface (m2/day) and the resulting serum vancomycin levels. We hypothesized that higher serum levels could be achieved based on doses calculated according to body surface.
Analysis of nosocomial Staphylococcus haemolyticus by MLST and MALDI-TOF mass spectrometry
2016, Infection, Genetics and EvolutionCitation Excerpt :The problem of hospital CoNS infections in NICUs is a very serious one and is related to immature immune responses of preterm infants and to frequent invasive procedures (Craft and Finer, 2001; Mohan et al., 2006). The main CoNS infections in NICUs include lung disease and sepsis, often associated with the use of catheters (Craft and Finer, 2001; Mohan et al., 2006). According to the microbiological monitoring carried out in NICUs of the Research Centre for Obstetrics, Gynecology and Perinatology in Moscow (RCOGP), CoNS are the most common group of microorganisms that cause infection, and Staphylococcus haemolyticus is the second most common species among CoNS after Staphylococcus epidermidis (Lubasovskaia et al., 2013).