Coagulase-negative staphylococci: interplay of epidemiology and bench research

Coagulase-negative staphylococci (CNS) are major nosocomial pathogens in patients with prostheses and indwelling devices such as central venous catheters. For Staphylococcus epidermidis the unique association with foreign-body infections appears to be due in part to a capsular polysaccharide adhesin that mediates attachment to silicon elastomer and other biomedical materials. In addition, staphylococcal "slime" may promote persistent colonization of indwelling devices and protect staphylococci from clearance by host defense mechanisms. Given these research findings, it seemed reasonable to assume that nosocomial CNS bacteremia in neonatal intensive care units might be associated with the use of indwelling vascular lines, as had been suggested by other investigators. We found that CNS cause the majority of nosocomial bacteremias in our neonatal intensive care units and that low birth weight and length of stay are major independent risk factors for these infections. In addition, we confirmed the association of central venous lines with CNS bacteremia but were surprised to find that intravenous administration of lipid emulsion was an even greater risk factor. These observations have brought our work back to the laboratory, where a rabbit model of CNS catheter infection is being studied to explore the relationship between lipid emulsion and catheter colonization and bacteremia.