Coagulase-negative staphylococci (CoNS) are reportedly responsible for 50–60% of bloodstream infections in very preterm (<1500 g) infants in neonatal intensive care units (NICUs). Staphylococcus capitis is an increasingly prevalent pathogen in the neonatal setting, frequently causing central-line-associated bloodstream infections (CLABSIs) that can be difficult to eradicate. Central venous catheter (CVC) removal versus in situ treatment with CoNS CLABSIs is a controversial treatment strategy with no clear consensus. We reviewed all S. capitis CLABSIs in our NICU between 2019 and 2022, focusing on the role of catheter removal in eradication. Among the 25 patients, 17 CVCs were removed after diagnosis, leading to a 76.5% eradication rate in this group. Three infants had a persistently positive blood culture after CVC substitution. A new catheter was then inserted after a 48 h washout period, resulting in resolution of the infection. Only two of the eight patients (25%) who retained their catheter after diagnosis achieved infection eradication with antibiotic therapy alone. When feasible, catheter removal seems to be the most effective strategy for eradicating S. capitis CLABSIs, sometimes even requiring a 48 h washout period before reinsertion. Further studies on this topic are needed to better standardize the management of this type of infection.

Background: Central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) pose a significant risk, especially for very low birth weight infants due to their immature immune systems and the need for invasive procedures. The implementation of evidence-based bundles, as recommended by international guidelines, has proven effective in significantly reducing CLABSI rates, improving clinical outcomes, and lowering hospital costs. However, evidence from long-term, real-world quality-improvement programs in European NICUs—especially those using repeated PDSA cycles and detailed monitoring across multiple periods—remains limited. Methods: This quality improvement prospective study, conducted in the NICU of “V. Buzzi” Children’s Hospital, aimed to reduce high CLABSI rates using a plan-do-study-act (PDSA) framework. A multidisciplinary team developed and implemented a new evidence-based central line bundle in 2021, focusing on standardized practices, enhanced training, and monitoring. The study analyzed 594 CVCs placed in 348 neonates across a total 4-years period (P1–P12). Results: Implementation of a central line bundle significantly reduced CLABSI rates from 29.1 to 2.2 per 1000 CVC days (p-value 0.002), with notable variations during intermediate periods. Birth weight and study period progression were the only variables significantly associated with CLABSI reduction. Conclusions: Infection rates dropped significantly post-intervention, achieving zero in one of the latest periods: continuous monitoring, staff training, and targeted interventions were pivotal. Future efforts will focus on refining practices, increasing tunneled centrally inserted central catheter (CICC) use, and sustaining prevention measures.

Coagulase negative Staphylococci (CoNS) are reported to be responsible for 50-60% of bloodstream infections in very preterm (<1500 g) infants in Neonatal Intensive Care Units (NICU). Staphylococcus capitis is an increasingly prevalent pathogen in neonatal setting, frequently causing central-line associated bloodstream infections (CLABSI) that can be difficult to eradicate. CVC removal versus in situ treatment of CoNS CLABSIs is a matter of debate, with no clear consensus emerging in the existing literature. We revised all S. capitis CLABSIs in our NICU between 2019 and 2022, focusing on the role of catheter removal for eradication. Among 25 cases, 17 CVCs were removed after diagnosis, leading to a 76.5% eradication rate in this group. 3 infants had a persistently positive blood culture after CVC substitution. A new catheter was than inserted after a 48-hours washout period, resulting in resolution of the infection. Only 2 of 8 patients (25%) who retained the catheter after diagnosis, underwent infection eradication with antibiotic therapy alone. Catheter removal, when feasible, seems to be the most effective strategy to eradicate S. capitis CLABSIs, sometimes even requiring a 48-hours washout period before reinsertion. Further studies on this subject are needed to better standardize the management of this kind of infections.