title: Heteroresistant Vancomycin Intermediate Coagulase Negative Staphylococcus in the NICU: A Systematic Review.
abstract: BACKGROUND
  NICUs in the province of Québec have seen an increase in hVICoNS, detected in the clinical laboratory.
  
  
  OBJECTIVE
  To investigate the clinical relevance of hVICoNS on the course of infection, and to determine the prevalence of hVICoNS sepsis in the NICU.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and PubMed from 1 January 1980 to 1 July 2016. Both observational and interventional studies were considered eligible if they provided data on hVICoNS in the NICU population. Two investigators independently reviewed studies for data extraction. Data extracted included: number of CoNS cultures, prevalence of hVICoNS, and clonality of strains.
  
  
  RESULTS
  Of the 613 studies identified, 19 studies were reviewed, and 5 studies included in the final review. No studies addressed the clinical significance of hVICoNS in the NICU. The prevalence of hVICoNS in the NICU varied greatly, ranging from 2.3% to 100%.
  
  
  CONCLUSIONS
  Publication bias could not be assessed, and risk of bias in some of the included studies due to small sample size and poor methods reporting. The quality of all included studies was low according to GRADE criteria, and the inclusion criteria restricted to either English or French studies.
  
  
  CONCLUSIONS
  Our review suggests that heteroresistance to vancomycin is much more common than previously believed. Our search however did not identify any studies that explicitly assessed any clinical implications of hVICoNS infections, thereby highlighting the need for research to assess the true impact of hVICoNS infection and to determine its significance on patient mortality and morbidity in the NICU.
authors.affiliation: Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Chong
authors.affiliation: Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Caya
authors.affiliation: Laboratoire de santé publique du Québec, Montreal, QC, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Lévesque
authors.affiliation: Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada.|Infectious Disease Division, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Caroline
authors.identifier: http://orcid.org/0000-0002-1170-9475
authors.initials: C
authors.lastname: Quach
mesh_terms: D003030:Coagulase / Q000378:metabolism*; D006801:Humans; D007363:Intensive Care Units, Neonatal; D011792:Quebec; D018805:Sepsis / Q000188:drug therapy / Q000378:metabolism; D013210:Staphylococcus / Q000187:drug effects*; D014640:Vancomycin / Q000627:therapeutic use*; D064887:Observational Studies as Topic
chemical_list: D003030:Coagulase; D014640:Vancomycin