DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20150979

Blood contamination in neonates: clinicians’ dilemma

Chandrakala R Iyer, Harsha PJ, Naveen G, Nagendra Katwe

Abstract


Background: Neonatal sepsis is an important cause of mortality and morbidity among neonates. Many laboratory tests aid to diagnose sepsis but isolation of bacteria in the blood is the gold standard for diagnosis of sepsis. Growth of contaminants in the blood nullifies the utility of blood culture. Coagulase Negative Staphylococcus aureus (CoNS) is a common blood contaminant, but it can be a pathogen among neonates admitted to intensive care unit. Difficulty in differentiating true infection of CoNS from blood contamination can results in inappropriate treatment of contaminants with antibiotics like vancomycin. There are advanced microbiological tests to distinguish true growth of CoNS from contaminants but they are not easily available and not cost effective in developing countries. There were numerous blood culture reports of CoNS and other contaminants from our neonatal intensive care unit of a rural based medical college hospital. Aim and objectives of the study were to differentiate true infection with positive blood cultures by correlation of clinical features, risk factors and clinical setting for CoNS sepsis.  

Methods: Retrospective case record analysis of 50 positive blood cultures for clinical significance of blood contaminants including CoNS.  

Results: Clinical correlation showed that 39 culture reports were false positives. Five positive blood cultures had pathogenic bacteria and six positive culture reports with blood contaminates and CoNS were true infection needed treatment with escalation of  antibiotics.

Conclusions: The source of blood contamination was from hospital environment probably due to lack of proper hand hygiene and blood sampling method. Implementation of quality control strategies on hand wash and blood collection method can reduce blood contamination.


Keywords


Blood contamination, Coagulase negative Staphylococcus, CoNS, Neonatal sepsis

Full Text:

PDF

References


Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013;4:306-9.

Sivanandan S, Soraisham AS, Swarnam K. Choice and duration of antimicrobial therapy for neonatal sepsis and meningitis. Int J Pediatr. 2011;2011:712150.

Nash C, Chu A, Bhatti M, Alexandar K, Schreiber M, Hageman JR. Coagulase negative Staphylococci in the neonatal intensive care unit: are we any smarter? Neo Rev. 2013;14(6):e284-93.

Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol. 2003;41(6):2275-8.

Paolucci M, Landini MP, Sambri V. How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr. 2012;2012:120139.

Premalatha DE, Mallikarjun K, Halesh LH, Siddesh KC, Prakash N. The bacterial profile and antibiogram of neonatal septicaemia in a tertiary care hospital. Int J Recent Trends Sci Technol. 2014;10(3):451-5.

Shah MN, Desai PB. Clinical and bacteriological profiles of blood culture positive sepsis in newborns. Int J Pharm Life Sci (IJPLS). 2011;2(9):1041-5.

Shrestha P, Das BK, Bhatta NK, Jha DK, Das B, Setia A, et al. Clinical and bacteriological profiles of blood culture positive sepsis in newborns. J Nepal Paediatr Soc. 2008;27:64-7.

Malik S, Ravishekhar K. Significance of coagulase negative staphylococcus species in blood culture. J Clin Diagn Res. 2012;6:632-5.

Hall KK, Lyman JA. Updated review of blood culture. Clin Microbiol Rev. 2006;19(4):788-802.

Hall RT, Domenico HJ, Self WH, Hain PD. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Pediatrics. 2013;131(1):e292-7.

Buttery JP. Blood cultures in newborns and children: optimising an everyday test. Arch Dis Child Fetal Neonatal Ed. 2002;87(1):F25-8.

Zakariya BP, Bhat V, Harish BN, Babu TA, Joseph NM. Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr. 2011;78(4):413-7.

Vital Statistics. Neonatal morbidity and mortality: report of the national neonatal-perinatal database. Indian Pediatr. 1997;34:1039-42.

Dias E, Vigneshwaran P. The bacterial profile of neonatal septicaemia in a rural hospital in South India. J Clin Diagn Res. 2010;(4):3327-30.

El-Jadba AH, El-Yazji MS. Neonatal septicemia in Gaza city hospitals. Pak J Med Sci. 2009;25:226-31.

Healy CM, Baker CJ, Palazzi DL, Campbell JR, Edwards MS. Distinguishing true coagulase-negative Staphylococcus infections from contaminants in the neonatal intensive care unit. J Perinatol. 2013;33(1):52-8.

Legeay C, Bourigault C, Lepelletier, D, Zahar JR. Prevention of healthcare-associated infections in neonates: room for improvement. J Hosp Infect. 2015;89(4):319-23.