Significance of coagulase negative staphylococci in neonates with late onset septicemia.

Present study was undertaken for establishing significance of coagulase negative staphylococci isolated from cases of late onset neonatal septicemia. 660 neonates admitted to NICU with clinical suspicion of late onset septicemia, over a period of nine months, were included in study. After skin preparation 1.5-ml blood for culture was collected from two different sites by venipuncture and each was inoculated into a blood culture bottle. All CONS thus isolated were further analysed. Laboratory criteria for significant CONS bacteremia was defined as recovery of CONS with in 48 hours of specimen collection from both sites of a blood culture set that displayed uniform antibiotic susceptibility and biochemical reactions. Due to technical difficulties two samples for blood culture were obtained only from 338 cases, CONS were recovered from 52 (22.7%) cases; only 13 (25%) were considered significant. Only single blood sample was available from remaining 322 subjects and CONS were recovered from 36/322 (24.3%). CONS isolation rate was similar in both subject groups. Using double specimen protocol we found majority of CONS recovered from neonates, to be probable contaminants. Recovery of CONS from blood of a septicemic neonate needs to be viewed with caution since not all of them are true bacteremic agents.

Trends in neonatal septicemia: emergence of non-albicans Candida.

In a prospective analysis, blood from 660 neonates admitted to neonatal Intensive Care Unit (NICU) of a teaching hospital with clinical suspicion of septicemia was cultured to look for etiological agents with particular reference to role of Candida species. Blood culture specimens from two different sites at same time were obtained to rule out possibility of a Candida isolate being a mere contaminant. Due to technical difficulties, this was possible in only 338 neonates (Group I); from remaining 322 neonates only single specimen was available (Group II). Candida was isolated from total 90 neonates (isolation rate 13.6%) and it was the single most common isolate. Majority were non-albicans Candida (germ tube test negative - 76/90). In group I, Candida was isolated from 66 neonates, of these 49 grew Candida in both specimens (significant candidemia). 44 records were available for analysis. Low birth weight was found in 73.3%. Crude mortality was 52.6%. A peak in isolation rate of Candida was noted (isolation rate 27%, p<0.05) in month of February. In Group I, 49 of the total 66 (74.2%) isolates of Candida were significant, suggesting that three in every four Candida isolated from blood can be significant. Non-albicans Candida are emerging as important pathogens for neonatal septicemia.