Download PDF
Am J Perinatol 2024; 41(09): 1245-1250
DOI: 10.1055/a-1817-5698
Original Article

The Validity of Positive Coagulase-Negative Staphylococcus Cultures for the Diagnosis of Sepsis in the Neonatal Unit

Shmuel Benenson
1   Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
Matan J. Cohen
2   Jerusalem district, Clalit Health Services, Hebrew University Faculty of Medicine, Jerusalem, Israel
,
Nofar Greenglick
1   Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
Carmela Schwartz
1   Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
Smadar Eventov-Friedman
3   Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
Zivanit Ergaz
3   Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

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.

  • No clinical/laboratory variables were associated with the diagnosis of true CoNS bacteremia.

Keywords

coagulase-negative Staphylococcus - bacteremia - sepsis


Publication History

Received: 19 October 2021

Accepted: 30 March 2022

Accepted Manuscript online:
05 April 2022

Article published online:
31 May 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bliss JM, Wynn JL. Editorial: the neonatal immune system: a unique host-microbial interface. Front Pediatr 2017; 5: 274
    CrossrefPubMedGoogle Scholar
  • 2 Schrag SJ, Farley MM, Petit S. et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138 (06) e20162013
    CrossrefPubMedGoogle Scholar
  • 3 Giannoni E, Agyeman PKA, Stocker M. et al; Swiss Pediatric Sepsis Study. Neonatal sepsis of early onset, and hospital-acquired and community-acquired late onset: a prospective population-based cohort study. J Pediatr 2018; 201: 106-114 .e4
    CrossrefPubMedGoogle Scholar
  • 4 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100 (03) F257-F263
    CrossrefPubMedGoogle Scholar
  • 5 Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Health Neonatol Perinatol 2017; 3: 5
    CrossrefPubMedGoogle Scholar
  • 6 El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ. et al. Risk factors for late-onset sepsis in preterm infants: a multicenter case-control study. Neonatology 2019; 116 (01) 42-51
    CrossrefPubMedGoogle Scholar
  • 7 Alsaied A, Islam N, Thalib L. Global incidence of necrotizing enterocolitis: a systematic review and Meta-analysis. BMC Pediatr 2020; 20 (01) 344
    CrossrefPubMedGoogle Scholar
  • 8 Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med 2014; 15 (06) 523-528
    CrossrefPubMedGoogle Scholar
  • 9 Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes. J Infect 2014; 68 (Suppl. 01) S24-S32
    CrossrefPubMedGoogle Scholar
  • 10 Shivanna V, Sunkappa SR, Venkatesha D. The rising trend of coagulase-negative staphylococci in neonatal septicemia. Indian J Pathol Microbiol 2016; 59 (04) 510-512
    CrossrefPubMedGoogle Scholar
  • 11 CDC. Bloodstream infection event (central line-associated bloodstream infection and non-central line associated bloodstream infection). Accessed April 13, 2022 at: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
    PubMedGoogle Scholar
  • 12 Golińska E, Strus M, Tomusiak-Plebanek A. et al. Coagulase-negative staphylococci contained in gut microbiota as a primary source of sepsis in low- and very low birth weight neonates. J Clin Med 2020; 9 (08) E2517
    CrossrefPubMedGoogle Scholar
  • 13 Marini MA, Truog AW. Reducing false-positive peripheral blood cultures in a pediatric emergency department. J Emerg Nurs 2013; 39 (05) 440-446
    CrossrefPubMedGoogle Scholar
  • 14 Murray PR, Baron E, Jorgensen J, Pfaller M, Landry ML. Manual of Clinical Microbiology. 9th ed.. Washington, DC: ASM Press; 2007
    Google Scholar
  • 15 Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacımustafaoglu M. Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7 year period: coagulase-negative Staphylococcus as the predominant pathogen. Pediatr Int 2014; 56 (01) 60-66
    CrossrefPubMedGoogle Scholar
  • 16 Ergaz Z, Benenson S, Cohen MJ, Braunstein R, Bar-Oz B. No change in antibiotic susceptibility patterns in the neonatal ICU over two decades. Pediatr Crit Care Med 2013; 14 (02) 164-170
    CrossrefPubMedGoogle Scholar
  • 17 Healy CM, Baker CJ, Palazzi DL, Campbell JR, Edwards MS. Distinguishing true coagulase-negative Staphylococcus infections from contaminants in the neonatal intensive care unit. J Perinatol 2013; 33 (01) 52-58
    CrossrefPubMedGoogle Scholar
  • 18 Marchant EA, Boyce GK, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative staphylococci. Clin Dev Immunol 2013; 2013: 586076
    CrossrefPubMedGoogle Scholar
  • 19 Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, Gallagher PG. Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci. J Pediatr 2015; 166 (05) 1193-1199
    CrossrefPubMedGoogle Scholar
  • 20 Bhattacharyya K, Bandyopadhyay M, Karmakar BC. et al. A study on blood culture positivity and C-reactive protein variability in neonatal septicaemia at neonatal intensive care unit of a tertiary care hospital. J Indian Med Assoc 2012; 110 (12) 920-921 , 925
    PubMedGoogle Scholar
  • 21 Brown JVE, Meader N, Wright K, Cleminson J, McGuire W. Assessment of C-reactive protein diagnostic test accuracy for late-onset infection in newborn infants: a systematic review and meta-analysis. JAMA Pediatr 2020; 174 (03) 260-268
    CrossrefPubMedGoogle Scholar
  • 22 Barhight M, Altaye M, Gist KM, Isemann B, Goldstein SL, Akinbi H. Nephrotoxic medications and associated acute kidney injury in very low birth weight infants. J Clin Nephrol Res 2017; 4 (04) 1070
    PubMedGoogle Scholar
  • 23 Greenberg RG, Benjamin Jr DK. Neonatal candidiasis: diagnosis, prevention, and treatment. J Infect 2014; 69 (Suppl. 01) S19-S22
    CrossrefPubMedGoogle Scholar
  • 24 Gibson MK, Wang B, Ahmadi S. et al. Developmental dynamics of the preterm infant gut microbiota and antibiotic resistome. Nat Microbiol 2016; 1: 16024
    CrossrefPubMedGoogle Scholar
  • 25 Silverman MA, Konnikova L, Gerber JS. Impact of antibiotics on necrotizing enterocolitis and antibiotic-associated diarrhea. Gastroenterol Clin North Am 2017; 46 (01) 61-76
    CrossrefPubMedGoogle Scholar
  • 26 Fajardo C, Alshaikh B, Harabor A. Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative cultures. J Matern Fetal Neonatal Med 2019; 32 (24) 4060-4066
    CrossrefPubMedGoogle Scholar
  • 27 Ting JY, Synnes A, Roberts A. et al. Canadian Neonatal Network I. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis. JAMA Pediatr 2016; 170 (12) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 28 Pallotto EK, Piazza AJ, Smith JR. et al; DNP; LNCC. Sustaining SLUG bug CLABSI reduction: does sterile tubing change technique really work?. Pediatrics 2017; 140 (04) e20163178
    CrossrefPubMedGoogle Scholar
  • 29 Sanderson E, Yeo KT, Wang AY. et al; NICUS Network. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect 2017; 97 (03) 267-274
    CrossrefPubMedGoogle Scholar