Preterm neonates: Role of CLABSI caused by Coagulase Negative Staphylococci

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Intravenous literature: Lepainteur, M., Desroches, M., Bourrel, A.S., Aberrane, S., Fihman, V., L’hériteau, F., Razafimahefa, H., Derouin, V., Doucet-Populaire, F. and Decousser, J.W. (2013) Role of the Central Venous Catheter in Bloodstream Infections Caused by Coagulase Negative Staphylococci in Very Preterm Neonates. The Pediatric Infectious Disease Journal. Feb 20th. [Epub ahead of print].

Abstract:

BACKGROUND: Pathogenesis of coagulase negative staphylococcal bloodstream infections among preterm neonates is debated: central venous catheters (CVC) are considered the major cause and the focus of prevention measures. The role of other means of transmission is unknown.

METHODS: We developed a specific quantitative PCR assay targeting the dnaJ gene from S. epidermidis and S. capitis to detect DNA from CVC used in preterms. Performance of the PCR was tested against two control groups of CVC yielding positive (n=24) or negative (n=63) conventional cultures. We also explored retrospectively the DNA load of CVC having a negative conventional bacterial culture and obtained from 34 very preterm neonates with catheter related bloodstream infections (CR-BSI) established by usual clinical and biologic criteria.

RESULTS: The molecular approach allowed detection of corresponding DNA from all the positive control catheters. Among the 34 episodes of CR-BSI yielding a negative conventional CVC culture, 8 (23.5%) had a positive PCR signal (5 S. epidermidis and 3 S. capitis). This percentage did not significantly differ according to the staphylococcal species, the delay between the CVC insertion and the beginning of the sepsis, or between the blood culture collection and the CVC removal. These results conform to the previously published 70% percentage of CR-BSI for whom the origin could be questioned.

CONCLUSIONS: CVC removal in preterms is often done in cases of CR-BSI; our study supports the hypothesis that in some cases the responsibility of CVC is questionable.

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