Should preterm neonates with a central venous catheter and coagulase negative staphylococcal bacteraemia be treated without removal of the catheter?

• Published in: Archives of disease in childhood 2003-05, Vol.88 (5), p.458-459
• Main Authors: Nistala, K, Nicholl, R
• Format: Article
• Language: English
• Subjects: Archimedes; Attrition (Research Studies); Body Weight; Care and treatment; Case studies; Catheterization, Central Venous - adverse effects; Catheters; Device Removal; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature, Diseases - drug therapy; Infants; Infants (Premature); Information Seeking; Medical instruments; Mortality; Neonates; Parenteral Nutrition - methods; Pregnancy; Premature infants; Risk Factors; Search Strategies; Staphylococcal Infections - drug therapy; Sterilization; Studies; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.88.5.458

Table 4 Coagulase negative staphylococcal bacteraemia in preterm neonates with a central venous catheter Citation Study group Study type (level of evidence) Outcome Key results Benjamin et al (2001) NICU inpatients with central venous catheter and CoNS bacteraemia (single positive culture) Retrospective case notes review (level 4) Prevalence of end organ damage (meningitis, osteomyelitis, abscess, death) Complicated bacteremia = end organ damage or >2 positive cultures Sterilisation of catheter was attempted in 72 of 84 neonates with CoNS bacteremia with salvage achieved in 51% without complications Attempt at sterilisation did not significantly increase complicated bacteremia; OR 7.9 (95% CI 0.97-64.5) Significant increased risk of end organ damage after 4 positive blood cultures v 3 or less; OR 29.6 (95% CI 4.7-186.1) Karlowicz et al (2002) NICU admission with CVC and CoNS bacteraemia (2 +ve culture, same organism) Observational cohort (level 4) Persistent bacteraemia (>3 days) Death 63 of 119 infants had attempted sterilisation of CVC with salvage in 46%; but a 30% absolute increase in persistent bacteraemia, NNH 3.3 (95% CI 2.2-6.8) No increase in death or recurrent bacteraemia None of 19 patients with bacteremia >4 days achieved catheter salvage Commentary Catheter related sepsis in preterm infants is a common neonatal problem (up to 15.3 infections per 1000 catheter days 1 ). [...]the criteria for removal of catheters was not standardised and the management and follow up of the two groups (catheter retained versus removed) may have differed.