By Barros M.

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A. Gary L. A. I. INTRODUCTION The skin is a multipurpose protective barrier for the developing neonate. Among the principal functions served by this barrier is prevention of infection. The dynamic balance between cutaneous colonization and infection is incompletely understood, but involves interplay between mechanical, biochemical, physiological, and immunological properties of the skin and characteristics of the microorganism such as ability to attach, survive, and replicate in the local environment and to express virulence factors necessary for causing infection (Table 1) (1).

Group A streptococci efficiently invade human respiratory epithelial cells. Proc Natl Acad Sci 1994; 91:12115– 12119. Schrager HM, Rheinwald JG, Wessels MR. Hyaluronic acid capsule and the role of streptococcal entry into keratinocytes in invasive skin infection. J Clin Invest 1996; 98:1954–1958. Schrager HM, Wessels MR. Hyaluronic acid capsule modulates interactions of group A streptococci with human epidermal keratinocytes. Adv Exp Med Biol 1997; 418:517–523. Darmstadt GL. Skin and Soft Tissue Infections.

Addition of 25g/mL of vancomycin to total pareteral nutrition solution decreased the rate of catheter colonization from 40 to 22% and dropped the rate of catheter-related sepsis from 15% to 0, while decreasing the need for catheter reinsertion and speeding the recovery of birth weight in treated infants (163). VII. CONCLUSION Bacterial colonization of the integument begins at birth. Organisms such as coagulase-negative staphylococci and diptheroids establish a lifelong com- 36 Sidbury and Darmstadt mensual residence, while others organisms may transiently attach, replicate, and ultimately infect the skin.

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