Challenges in the Prevention of Coagulase-Negative Staphylococcal Sepsis in Neonates

textabstractCoagulase-negative staphylococci (CoNS) are the leading cause of late-onset sepsis (LOS) worldwide. As antibiotic resistance is dramatically increasing in these organisms, prevention is becoming more and more important. CoNS that are isolated from blood cultures of neonates with LOS on neonatal intensive care units (NICU) are mostly clonally related. Furthermore, there is a correlation between antibiotic resistance and biofilm production in CoNS. NICU personnel play an important role in the transmission of virulent CoNS strains, as 90% of the strains isolated from blood cultures can be found on the hands of NICU personnel. Hand hygiene is therefore important in the prevention of CoNS LOS. During hospitalization, CoNS on the skin of neonates become increasingly antibiotic resistant. Over time the CoNS species also change. Neonates with multiresistant CoNS in the first 72 hours after birth have a higher risk for developing CoNS LOS. Analysis of surface-exposed proteins of Staphylococcus epidermidis shows a role for SesC in biofilm production. Antibodies against SesC inhibit biofilm production. SesC is therefore an interesting target for prevention and treatment of S. epidermidis biofilms. A review of literature shows that hand hygiene is the most important readily implementable prevention strategy against CoNS. Other strategies, for example administering antibiotics when removing intravascular catheters, may also add to a reduction of CoNS LOS