Quantitative skin cultures at potential catheter sites in neonates

To identify and quantify the bacterial and fungal flora present at body sites used for vascular catheterization of infants in a neonatal intensive care unit.

Quantitative skin cultures were obtained from a group of neonatal patients to determine the bacterial flora found on the skin at four sites. Quantitative cultures of the jugular, subclavian, umbilical, and femoral sites were obtained on 50 infants, ranging in age from 2 days to 3 months old.

The neonatal intensive care unit of St. Christopher's Hospital for Children, a university-affiliated tertiary care children's hospital.

Colony counts ranged from 0 to 10(6) colony-forming units/10 cm2. Types of organisms found were consistent with other published studies and included coagulase-negative staphylococci, Staphylococcus aureus, yeast, aerobic gram-negative rods, Enterococcus species, Corynebacterium species, and alpha-hemolytic streptococci. There was a significantly higher mean colony count at the combined jugular/femoral sites versus the subclavian site (P < 0.01) and umbilical site (P < 0.05). Mean colony counts did not differ significantly between the jugular and femoral site, or between the subclavian and umbilical site. The umbilical site was more likely to be colonized with aerobic gram-negative rods, Enterococcus species, and yeast, while the subclavian had coagulase-negative staphylococci as the predominant organism. The jugular and femoral sites demonstrated a higher colony count of aerobic gram-negative rods, Enterococcus species and yeast than the other sites. If central venous catheters need to be in place for extended periods of time, placement at a site with lower bacterial densities on the skin may help minimize catheter-associated infections. This study supports the subclavian as the preferred site.