Risks of treating infected neonatal lines
Hodge and Puntis1 suggest that “up to 80% of coagulase negative staphylococcus infection … in young children can be eradicated with antibiotics”. The study referenced, Raad et al,2 was carried out in adults (mean age 43 years) with underlying malignancy, most of whom had non-tunnelled subclavian lines. It may not be appropriate to apply Raad et al’s results to children with long term parental nutrition, in view of the differences in age, illness, and catheter type.
The authors endorse the treatment of infected central venous catheters in situ without an adequate appraisal of the risks. In the neonatal population retention of catheters has a lower success rate than suggested, with only 50% of catheters being successfully treated.3
Importantly, treating catheters rather than immediate removal significantly prolonged the bacteremia. The risk of bacterial end organ damage increases with each day that there are positive cultures.4
