Abstract
A positive blood culture with a clinically recognized pathogen remains the gold standard for the diagnosis of neonatal sepsis. Debate continues as to whether multiple blood cultures should be performed. Certainly with bacterial organisms that are frequent blood culture contaminants, such as coagulase-negative staphylococci (CoNS), the diagnosis of sepsis is best confirmed by the finding of two or more positive cultures from multiple sites or body fluids that are normally sterile. The isolation of CoNS from only one blood culture when only one is obtained is problematic and of uncertain significance. Since many of these positive cultures represent contamination with skin microflora, the practice of obtaining only one blood culture often leads to prolonged and unnecessary antibiotic therapy. In our neonatal intensive care unit (NICU) at Parkland Memorial Hospital (PMH) in Dallas, Texas, we routinely obtain two blood cultures from all infants who are evaluated for possible sepsis.
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References
Benjamin, D.K., Jr., Miller, W., Garges, H., Benjamin, D.K., McKinney, R.E., Jr., Cotton, M. et al. (2001). Bacteremia, central catheters, and neonates: When to pull the line. Pediatrics 107, 1272–1276.
Bryan, C.S., John, J.F., Jr., Pai, M.S., and Austin, T.L. (1985). Gentamicin vs cefotaxime for therapy of neonatal sepsis. Am. J. Dis. Child 139, 1086–1089.
Butler, K.M., Rench, M.A., and Baker, C.J. (1990). Amphotericin B as a single agent in the treatment of systemic candidiasis in neonates. Pediatr. Infect. Dis. J. 9, 51–56.
Dato, V.M. and Dajani, A.S. (1990). Candidemia in children with central venous catheters: Role of catheter removal and amphotericin B therapy. Pediatr. Infect. Dis. J. 9, 309–314.
de Man, P., Verhoeven, B.A., Verbrugh, H.A., Vos, M.C., and van den Anker, J.N. (2000). An antibiotic policy to prevent emergence of resistant bacilli. Lancet 355, 973–978.
Eppes, S.C., Troutman, J.L., and Gutman, L.T. (1989). Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr. Infect. Dis. J. 8, 99–104.
Franz, A.R., Steinbach, G., Kron, M., and Pohlandt, F. (1999). Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 104, 447–453.
Hengst, J.M. (2003). The role of C-reactive protein in the evaluation and management of infants with suspected sepsis. Adv. Neonatal Care 3, 3–13.
Jackson, G.L., Sendelbach, D.M., Stehel, E.K., Baum, M., Manning, M.D., and Engle, W.D. (2003). Association of hypocalcemia with a change in gentamicin administration in neonates. Pediatr. Nephrol. 18, 653–656.
Karlowicz, M.G., Hashimoto, L.N., Kelly, R.E., Jr., and Buescher, E.S. (2000a). Should central venous catheters be removed as soon as candidemia is detected in neonates? Pediatrics 106, E63.
Karlowicz, M.G., Buescher, E.S., and Surka, A.E. (2000b). Fulminant late-onset sepsis in a neonatal intensive care unit 1988-1997, and the impact of avoiding empiric vancomycin therapy. Pediatrics 106, 1387–1390.
Karlowicz, M.G., Furigay, P.J., Croitoru, D.P., and Buescher, E.S. (2002). Central venous catheter removal versus in situ treatment in neonates with coagulase-negative staphylococcal bacteremia. Pediatr. Infect. Dis. J. 21(1), 22–27.
Kaufman, D., Boyle, R., Hazen, K.C., Patrie, J.T., Robinson, M., and Donowitz, L.G. (2001). Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N. Engl. J. Med. 345, 1660–1666.
Keyserling, H.L., Sinkowitz-Cochran, R.L., Harris, J.M. 2nd, Levine, G.L., Siegel, J.D., Stover, B.H. et al., and the Pediatric Prevention Network. (2003). Vancomycin use in hospitalized pediatric patients. Pediatrics 112(2), E104–E111.
Kicklighter, S.D., Springer, S.C., Cox, T., Hulsey, T.C., and Turner, R.B. (2001). Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 107, 293–298.
Nambiar, S. and Singh, N. (2002). Change in epidemiology of health care-associated infections in a neonatal intensive care unit. Pediatr. Infect. Dis. J. 21, 839–842.
Patterson, J.E. (2002). Extended spectrum beta-lactamases: A therapeutic dilemma. Pediatr. Infect. Dis. J. 21, 957–959.
Rubin, L.G., Sánchez, P.J., Siegel, J., Levine, G., Saiman, L., Jarvis, W.R., and the Pediatric Prevention Network. (2002). Evaluation and treatment of neonates with suspected late-onset sepsis: A survey of neonatologists’ practices. Pediatrics 110(4), E42.
Saiman, L., Ludington, E., Dawson, J.D., Patterson, J.E., Rangel-Frausto, S., Wiblin, R.T. et al., and National Epidemiology of Mycoses Study Group. (2001). Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr. Infect. Dis. J. 20, 1119–1124.
Sánchez, P.J., Gard, J.W., Dao, R., Leos, N.K., and Perlman, J. (1998). Impact of a protocol for reduction of vancomycin use in a neonatal intensive care unit. The 38th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 24-27, 1998, San Diego, CA.
Sánchez, P.J., Mohamed, W.A., Gard, J.W., Gaffney, D., Byrd, L., Zeray, F., and Leos, N.K. (1999). Use of a vancomycin-reduction protocol in a neonatal intensive care unit: What’s the outcome? Presented at the 37th Annual Meeting of the Infectious Diseases Society of America, November 1999, Philadelphia, PA.
Singh, N., Patel, K.M., Leger, M.M., Short, B., Sprague, B.M., Kalu, N., and Campos, J.M. (2002). Risk of resistant infections with Enterobacteriaceae in hospitalized neonates. Pediatr. Infect. Dis. J. 21, 1029–1033.
Stamos, J.K. and Rowley, A.H. (1995). Candidemia in a pediatric population. Clin. Infect. Dis. 20, 571–575.
Stoll, B.J., Hansen, N., Fanaroff, A.A., Wright, L.L., Carlo, W.A., Ehrenkranz, R.A. et al. (2002a). Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics 110, 285–291.
Stoll, B.J., Hansen, N., Fanaroff, A.A., Wright, L.L., Carlo, W.A., Ehrenkranz, R.A. et al. (2002b). Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N. Engl. J. Med. 347(4), 240–247.
Van Houten, M.A., Uiterwaal, C.S.P.M., Heesen, G.J.M., Arends, J.P., and Kimpen, J.L.L. (2001). Does the empiric use of vancomycin in pediatrics increase the risk for Gram-negative bacteremia? Pediatr. Infect. Dis. J. 20, 171–177.
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Sánchez, P.J. (2004). Bacterial and Fungal Infections in the Neonate: Current Diagnosis and Therapy. In: Pollard, A.J., McCracken, G.H., Finn, A. (eds) Hot Topics in Infection and Immunity in Children. Advances in Experimental Medicine and Biology, vol 549. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-8993-2_14
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DOI: https://doi.org/10.1007/978-1-4419-8993-2_14
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