Published online June 1, 2006
PEDIATRICS
Vol. 117
No. 6
June 2006, pp.
2330-2331
(doi:10.1542/peds.2006-0573)
Persistent Bacteremia in Neonates
Dror Mandel, MD
Shaul Dollberg, MD
Francis B. Mimouni, MD
Department of Neonatology
Lis Maternity Hospital
Tel Aviv Sourasky Medical Center
Tel Aviv 64239, Israel
To the Editor.—
We read with interest the Khashu et al article "Persistent Bacteremia and Severe Thrombocytopenia Caused by Coagulase-Negative Staphylococcus in a Neonatal Intensive Care Unit."1 In their article, Khashu et al report a "new syndrome of CoNS [coagulase-negative Staphylococcus] sepsis characterized by persistent bacteremia and severe thrombocytopenia despite aggressive antibiotic therapy and absence of any obvious endovascular focus" that appeared in a small series of 31 infants.1
We refer the authors to an article of ours that describes the same phenomenon in 46 infants who also were affected by persistent bacteremia.2 Similar to the description by Khashu et al, our patients were also affected by a significant decrease in thrombocyte counts, had no obvious endovascular focus, and had prolonged bacteremia (6–20 days) despite aggressive and adequate antibiotic therapy. However, in our article, in contrast to the findings of Khashu et al, we reported that most patients had Gram-negative infections, as is the case in most patients with nosocomial infections in our institution. Thus, the "new syndrome" described by Khashu et al and previously reported by us is not exclusively a result of CoNS and is probably due to agents that predominate in a given nursery.
Khashu et al state in their retrospective report that in their patients there was no "obvious endovascular focus." This statement is limited by the fact that an echocardiogram was performed on only 18 of the 31 infants with persistent bacteremia, and for none was a bone scan performed or reported. Moreover, Khashu et al did not look specifically for subcutaneous abscesses that may be easily overlooked (as pointed out in our article), that were usually not present (or discovered) at the onset of the signs of sepsis, and that were present in 22% of the infants with persistent bacteremia.
We hope these comments will help enhance the importance of the topic of persistent bacteremia in neonates.
REFERENCES
- Khashu M, Osiovich H, Henry D, Al Khotani A, Solimano A, Speert DP. Persistent bacteremia and severe thrombocytopenia caused by coagulase-negative Staphylococcus in a neonatal intensive care unit.
Pediatrics. 2006;117
:340
–348[Abstract/Free Full Text]
- Mandel D, Littner Y, Mimouni FB, Dollberg S. Nosocomial cutaneous abscesses in septic infants.
Arch Dis Child Fetal Neonatal Ed. 2004;89
:F161
–F162[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
