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Role of the Central Venous Catheter in Bloodstream Infections Caused by Coagulase-negative Staphylococci in Very Preterm Neonates

Lepainteur, Margaux PharmD*†; Desroches, Marine PharmD*†; Bourrel, Anne Sophie PharmD*†; Aberrane, Said MD; Fihman, Vincent PharmD§; L’Hériteau, François MD; Razafimahefa, Hasini MD; Derouin, Véronique MD*; Doucet-Populaire, Florence PharmD, PhD*†; Decousser, Jean-Winoc PharmD, PhD*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318289de0f
Original Studies
Abstract

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

Methods: We developed a specific quantitative polymerase chain reaction assay targeting the dnaJ gene from Staphylococcus epidermidis and Staphylococcus capitis to detect DNA from CVC used in preterms. Performance of the polymerase chain reaction was tested against 2 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-BSIs) 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 polymerase chain reaction 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% of CR-BSI for whom the origin could be questioned.

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

Author Information

From the *Department of Bacteriology and Infection Control, Assistance Publique – Hôpitaux de Paris, University Hospital Antoine-Béclère, Clamart; EA 4043, USC INRA, Université Paris-Sud 11, Faculté de Pharmacie Chatenay Malabry; Laboratory of Microbiology, Intercommunal Hospital of Créteil, Créteil; §Laboratory of Microbiology and Infection Control, Assistance Publique – Hôpitaux de Paris, University Hospital Louis Mourier, Colombes; CCLIN Paris Nord, 96 rue Didot, Paris; and Neonatal Intensive Care Unit, AP-HP, University Hospital Antoine-Béclère, Clamart, France.

Accepted for publication January 25, 2013.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Jean-Winoc Decousser, PharmD, PhD, Department of Virology, Bacteriology – Infection Control, Parasitology – Mycology, AP-HP, University Hospital Henri Mondor, 94000 Créteil, France. E-mail: jean-winoc.decousser@hmn.aphp.fr.

© 2013 Lippincott Williams & Wilkins, Inc.