COAGULASE NEGATIVE STAPHYLOCOCCUS (CONS) IN BLOOD CULTURES, NORMAL SERUM C-REACTIVE PROTEIN (CRP) AND LOW SERUM INTERLEUKIN-6 (IL-6) : CAN TREATMENT BE TRUNCATED? 1763

Abstract

CONS in positive blood cultures are often contaminants, yet infants are given antibiotics over needlessly prolonged periods of time. The resultant widespread use of antimicrobials has added to the longstanding problem of antimicrobial resistant organisms, particularly in the closed environment of the NICU. We used normal CRP levels as an indication to discontinue treatment 48 hours after inception. CONS positive blood cultures and normal CRP q 12h× 3 (<1.0 mg/dl) occurred in 43 “septic work-ups” (41 infants). Duration of antimicrobial therapy was <48 hours in 23 episodes and ≥48 hours in 20, as directed by attending neonatologists. When clinically indicated, cultures were repeated within 72 hours of last antimicrobial doses. All were negative. For this total group of 43 infants with normal CRP, the mean highest IL-6 within 48 hours of onset was 61.4 pg/dl. In another cohort of CONS positive cultures but with elevated CRP, mean IL-6 was 1,291 pg/dl. The benign outcomes after therapies <48 hours and the low serum IL-6 levels suggest that normal CRP levels reliably indicate that treatment can be truncated.