The value of surveillance cultures on neonatal intensive care units.

Nosocomial infections on neonatal intensive care units (NICUs) have been a recognized cause for concern for many years. It is the endeavour of the doctors caring for these children to identify and treat such infections as early as possible in an effort to reduce morbidity and mortality to a minimum. A high percentage of babies on NICU become colonized with Gram-negative bacilli (GNB) with increasing length of stay on the unit. Those babies that remain on NICU for prolonged periods, and who become colonized, tend to be the most premature and sickest infants, and therefore are most at risk of becoming septic. The use of surface cultures in predicting the organisms responsible for sepsis is inefficient and not cost-effective. There is some evidence that endotracheal aspirate cultures in ventilated neonates may be helpful in identifying the pathogens responsible for perinatal pneumonia. Most NICUs have an antibiotic policy for the blind treatment of sepsis which covers the most common organisms responsible, and it is likely that antimicrobial treatment is rarely altered as a result of pathogens isolated from surface cultures. Again this makes the collection of surface cultures a wasteful and costly use of resources. In the light of the increasing incidence of Gram-positive infections on NICUs, antibiotic policies may have to be altered to accommodate these pathogens. As well as continued attention to good infection control measures, it remains with the clinician to be alert to the onset of sepsis in neonates and institute broad spectrum antimicrobial cover after collecting blood and cerebrospinal fluid cultures as indicated.(ABSTRACT TRUNCATED AT 250 WORDS)