138 COAGULASE NEGATIVE STAPHYLOCOCCI (CMS) ARE TRUE PATHOGENS IN NEWBORN INFANTS: A PROSPECTIVE COHORT STUDY

We compared prospectively newborn infants with CNS bacteraemia (group 1) to infants with sepsis due to recognized pathogens (group 2), controls (group 3) and infants with suspected infection but negative blood-cultures (group 4). Ten clinical signs, complete blood cell counts and acute phase proteins (C-reactive protein, α1-acidglycoprotein, prealbumin) were recorded at the time of culture. 31 of 799 blood cultures (10.1%) became CNS positive, 25 (3%) grew other pathogens. 70 controls were matched to CNS positive cases for birthweight, gestational age and postnatal age.Logistic regression analysis demonstrated only marginal differences between groups 1 and 2, with lethargy being more common in group 2 (p ≤ 0.05). Significant differences were found between group 1 and groups 3 and 4, respectively. CRP was the single best laboratory discriminator (p ≤ 0.001) and superior to all haematological tests of which the best was the immature/total neutrophil ratio. Hyperthermia, increased FiO2 requirements ≥ 15% and lethargy were the best clinical signs. Specificity of discriminating variables was consistently higher than sensitivity.We conclude that (1) CNS is a true pathogen in newborns and (2) a normal CRP and the absence of hyperthermia, increased FiO2 requirements and lethargy are most useful in predicting infants whose blood cultures will remain negative.