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Reservoirs of coagulase negative staphylococci in preterm infants
K Eastick1, J P Leeming, D Bennett
1Bristol Public Health Laboratory, Bristol Royal Infirmary.
Insights
Coagulase-negative staphylococci (CoNS) form reservoirs on infant skin and in feces. Preventing CoNS spread between sites on the same infant is crucial for reducing bloodstream infections.
Area of Science:
- Microbiology
- Neonatal Care
- Infectious Disease Prevention
Background:
- Coagulase-negative staphylococci (CoNS) are a significant cause of healthcare-associated infections in neonates.
- Understanding CoNS colonization patterns on infant skin and in the gut is essential for infection control.
Purpose of the Study:
- To determine the magnitude and interrelations of CoNS reservoirs on infant skin and in feces.
- To identify key CoNS colonization sites during the first six months of life.
- To inform strategies for preventing CoNS bloodstream infections in neonates.
Main Methods:
- Sampling of 16 skin sites and stools from preterm neonates.
- Detailed survey of CoNS in stool and at six skin sites over six months.
- Characterization of CoNS isolates: speciation, antibiotic susceptibility, and plasmid analysis.
Main Results:
- Large, stable CoNS reservoirs identified in feces, around the ear, axilla, and nares.
- Forearm and leg skin sites, common for catheter insertion, showed small, unstable CoNS numbers.
- CoNS at catheter sites were often indistinguishable from those at other body sites on the same infant.
Conclusions:
- Contamination of catheter sites by CoNS from other body sites on the same infant is a likely transmission route.
- Interventions reducing same-infant cross-contamination may be as vital as inter-infant infection control.
- Healthcare practices, like diaper changes, leading to hand contamination require careful attention.
Abstract:
This investigation was undertaken to determine the magnitude of, and interrelations between, reservoirs of coagulase negative staphylococci on infants' skin at various sites (including sites used for insertion of intravascular catheters) and in faeces during the first six months of life. Sites with large numbers of coagulase negative staphylococci were identified by sampling 16 skin sites and stools from 20 preterm neonates at 8-30 days of life. A more detailed survey of numbers and types of coagulase negative staphylococci in stool and at six skin sites of 10 preterm infants was then performed over the first six months of life. Isolates of coagulase negative staphylococci were collected and characterised by speciation, antibiotic susceptibility profiling, and plasmid restriction fragment length polymorphism analysis. Large, relatively stable reservoirs were identified in the faeces, around the ear, and in the axilla and nares. Skin on the forearm and leg, sites at which peripheral catheters are frequently sited, carried small unstable numbers of coagulase negative staphylococci, which were usually indistinguishable from coagulase negative staphylococci isolated from other body sites on the same baby. Contamination of catheter insertion sites with coagulase negative staphylococci from reservoir sites on the same baby could explain these observations. These data suggest that interventions reducing cross-contamination between sites on the same baby might be as important in preventing coagulase negative staphylococcal bacteraemias as measures taken to prevent cross infection between babies. Procedures which are likely to result in heavy coagulase negative staphylococcal contamination of the hands of healthcare staff, such as changing soiled nappies, should receive particular attention.