title: Central venous catheter removal versus in situ treatment in neonates with coagulase-negative staphylococcal bacteremia.
abstract: OBJECTIVE
  To determine how often neonates with coagulase-negative staphylococcal (CONS) bacteremia can be treated successfully without removing the central venous catheter (CVC).
  
  
  METHODS
  A cohort study of CONS bacteremia and CVCs was conducted in infants in a neonatal intensive care unit in a 5-year period (1994 through 1998). CONS bacteremia was defined as at least two positive blood cultures within 3 days of each other.
  
  
  RESULTS
  Fifty-six infants had early removal CVC (ER-CVC) within 3 days, and 63 infants had late removal CVC (LR-CVC) >3 days after the first positive blood culture. All cases of CONS bacteremia were treated with vancomycin. There was no significant difference between infants in the ER-CVC and LR-CVC groups in terms of recurrence of bacteremia or case fatalities. CONS bacteremia of >3 days duration was more frequent in LR-CVC patients than ER-CVC patients: 43% vs. 13% (relative risk, 3.4; 95% confidence interval, 1.6 to 7.2). CONS bacteremia was successfully treated without CVC removal in 46% of LR-CVC cases. Seventy-nine percent of LR-CVC cases with CONS bacteremia lasting 1 or 2 days were treated successfully without CVC removal. The success rate decreased to 44% with a 3- to 4-day duration of bacteremia. None of 19 infants with CONS bacteremia lasting >4 days was treated successfully until CVCs were removed.
  
  
  CONCLUSIONS
  Prolonged CONS bacteremia was avoided by early removal of CVCs. Retention of CVCs was successful in 46% of neonates with CONS bacteremia in whom it was attempted, but it was never successful if bacteremia lasted >4 days.
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA. GKarlowi@CHKD.com
authors.forename: M Gary
authors.initials: MG
authors.lastname: Karlowicz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Furigay
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Croitoru
authors.forename: E Stephen
authors.initials: ES
authors.lastname: Buescher
mesh_terms: D016470:Bacteremia / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003030:Coagulase / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000628:therapy*; D013997:Time Factors
chemical_list: D003030:Coagulase