1887

Abstract

This study examined the pattern of colonization of the neonatal gut by aerobic Gram-negative bacilli (GNB) and evaluated the association between gut colonization and sepsis in the developing world. This deserves attention because of the high incidence of sepsis and the differences in hygienic environments in developing countries compared with the developed world. The study was carried out on neonates in a tertiary-care government hospital. Serial gut samples were analysed (gastric aspirates and stool samples) for GNB. Blood samples of cases showing clinical signs of sepsis were also analysed for septic screening and culture positivity. Antibiograms, serotyping and PFGE were carried out to evaluate the relatedness of the gut and blood isolates. A diverse array of GNB was isolated from the gut of the neonates, being most common, followed by . The rate of isolation of GNB was consistently higher in stool samples compared with gastric aspirate samples. Colonization was influenced by a stay in the neonatal intensive care unit and by the prolonged use of a feeding tube. GNB were the cause of sepsis in the majority of cases, with being the most frequently isolated GNB from the blood. , , and were the other GNB recovered from the blood of the neonates. Neonates with GNB in the gut had a higher incidence of clinical sepsis than those without. In 50 % of cases, the genotypes of the organisms found in the blood were indistinguishable from their gut counterpart. These results show that the neonatal gut is colonized with a diverse array of GNB, and an association between gut colonization and neonatal sepsis was observed.

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2011-11-01
2024-12-13
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References

  1. Adlerberth I., Carlsson B., de Man P., Jalil F., Khan S. R., Larsson P., Mellander L., Svanborg C., Wold A. E., Hanson L. A. 1991; Intestinal colonization with Enterobacteriaceae in Pakistani and Swedish hospital-delivered infants. Acta Paediatr Scand 80:602–610 [View Article][PubMed]
    [Google Scholar]
  2. Bennet R., Eriksson M., Tafari N., Nord C. E. 1991; Intestinal bacteria of newborn Ethiopian infants in relation to antibiotic treatment and colonisation by potentially pathogenic Gram-negative bacteria. Scand J Infect Dis 23:63–69 [View Article][PubMed]
    [Google Scholar]
  3. Berg R. D. 1995; Bacterial translocation from the gastrointestinal tract. Trends Microbiol 3:149–154 [View Article][PubMed]
    [Google Scholar]
  4. Black R. E., Cousens S., Johnson H. L., Lawn J. E., Rudan I., Bassani D. G., Jha P., Campbell H., Walker C. F. et al. 2010; Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375:1969–1987 [View Article][PubMed]
    [Google Scholar]
  5. Bonten M. J., Slaughter S., Ambergen A. W., Hayden M. K., van Voorhis J., Nathan C., Weinstein R. A. 1998; The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 158:1127–1132 [View Article][PubMed]
    [Google Scholar]
  6. Bradford P. A. 2001; Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 14:933–951 [View Article][PubMed]
    [Google Scholar]
  7. Chiesa C., Panero A., Osborn J. F., Simonetti A. F., Pacifico L. 2004; Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem 50:279–287 [View Article][PubMed]
    [Google Scholar]
  8. Chugh T. D., Ghaffoor S. A., Kuruvilla A. C., Bishbishi E. A. 1985; Colonization and infections of neonates by Klebsiella pneumoniae in an intensive care unit. J Trop Pediatr 31:200–203[PubMed] [CrossRef]
    [Google Scholar]
  9. CLSI 2008; Performance Standards for Antimicrobial Susceptibility Testing. 18th Information Supplement M100–S18. Wayne, PA: Clinical and Laboratory Standards Institute;
  10. Corbella X., Montero A., Pujol M., Domínguez M. A., Ayats J., Argerich M. J., Garrigosa F., Ariza J., Gudiol F. 2000; Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii . J Clin Microbiol 38:4086–4095[PubMed]
    [Google Scholar]
  11. Donnell S. C., Taylor N., van Saene H. K., Magnall V. L., Pierro A., Lloyd D. A. 2002; Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study. J Hosp Infect 52:273–280 [View Article][PubMed]
    [Google Scholar]
  12. Donskey C. J. 2004; The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39:219–226 [View Article][PubMed]
    [Google Scholar]
  13. Edmond K., Zaidi A. 2010; New approaches to preventing, diagnosing, and treating neonatal sepsis. PLoS Med 7:e1000213 [View Article][PubMed]
    [Google Scholar]
  14. Graham P. L. III, Della-Latta P., Wu F., Zhou J., Saiman L. 2007; The gastrointestinal tract serves as the reservoir for Gram-negative pathogens in very low birth weight infants. Pediatr Infect Dis J 26:1153–1156 [View Article][PubMed]
    [Google Scholar]
  15. Guarner F., Malagelada J. R. 2003; Gut flora in health and disease. Lancet 361:512–519 [View Article][PubMed]
    [Google Scholar]
  16. Hart C. A. 1993; Klebsiella and neonates. J Hosp Infect 23:83–86 [View Article]
    [Google Scholar]
  17. Hurrell E., Kucerova E., Loughlin M., Caubilla-Barron J., Hilton A., Armstrong R., Smith C., Grant J., Shoo S., Forsythe S. 2009; Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae . BMC Infect Dis 9:146 [View Article][PubMed]
    [Google Scholar]
  18. Kristóf K., Szabó D., Marsh J. W., Cser V., Janik L., Rozgonyi F., Nobilis A., Nagy K., Paterson D. L. 2007; Extended-spectrum β-lactamase-producing Klebsiella spp. in a neonatal intensive care unit: risk factors for the infection and the dynamics of the molecular epidemiology. Eur J Clin Microbiol Infect Dis 26:563–570 [View Article][PubMed]
    [Google Scholar]
  19. MacFie J. 2004; Current status of bacterial translocation as a cause of surgical sepsis. Br Med Bull 71:1–11 [View Article][PubMed]
    [Google Scholar]
  20. MacFie J., O’Boyle C., Mitchell C. J., Buckley P. M., Johnstone D., Sudworth P. 1999; Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut 45:223–228 [View Article][PubMed]
    [Google Scholar]
  21. Magne F., Suau A., Pochart P., Desjeux J. F. 2005; Fecal microbial community in preterm infants. J Pediatr Gastroenterol Nutr 41:386–392 [View Article][PubMed]
    [Google Scholar]
  22. Mancini N., Carletti S., Ghidoli N., Cichero P., Burioni R., Clementi M. 2010; The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev 23:235–251 [View Article][PubMed]
    [Google Scholar]
  23. NNPD 2005; National Neonatal-Perinatal Database Report 2002–2003 . India: National Neonatology Forum;
  24. Paul V. K. 2006; The current state of newborn health in low income countries and the way forward. Semin Fetal Neonatal Med 11:7–14 [View Article][PubMed]
    [Google Scholar]
  25. Pierro A., van Saene H. K., Jones M. O., Brown D. A., Nunn A. J., Lloyd D. A. 1998; Clinical impact of abnormal gut flora in infants receiving parenteral nutrition. Ann Surg 227:547–552 [View Article][PubMed]
    [Google Scholar]
  26. Richards C., Alonso-Echanove J., Caicedo Y., Jarvis W. R. 2004; Klebsiella pneumoniae bloodstream infections among neonates in a high-risk nursery in Cali, Colombia. Infect Control Hosp Epidemiol 25:221–225 [View Article][PubMed]
    [Google Scholar]
  27. Salyers A. A., Gupta A., Wang Y. 2004; Human intestinal bacteria as reservoirs for antibiotic resistance genes. Trends Microbiol 12:412–416 [View Article][PubMed]
    [Google Scholar]
  28. Schwartz S. N., Dowling J. N., Benkovic C., DeQuittner-Buchanan M., Prostko T., Yee R. B. 1978; Sources of Gram-negative bacilli colonizing the tracheae of intubated patients. J Infect Dis 138:227–231 [View Article][PubMed]
    [Google Scholar]
  29. Schwiertz A., Gruhl B., Löbnitz M., Michel P., Radke M., Blaut M. 2003; Development of the intestinal bacterial composition in hospitalized preterm infants in comparison with breast-fed, full-term infants. Pediatr Res 54:393–399 [View Article][PubMed]
    [Google Scholar]
  30. Sharma R., Young C., Mshvildadze M., Neu J. 2009; Intestinal microbiota: does it play a role in diseases of the neonate?. NeoReviews 10:166–179 [View Article]
    [Google Scholar]
  31. National Neonatology Forum & Save the Children 2004; State of India’s Newborns . New Delhi/Washington, DC: National Neonatology Forum & Save the Children/US;
  32. United Nations Children’s Fund 2009; The State of the World’s Children 2009. Maternal and Neonatal Health . New York, USA: United Nations Children’s Fund;
  33. van Saene H. K., Taylor N., Donnell S. C., Glynn J., Magnall V. L., Okada Y., Klein N. J., Pierro A., Lloyd D. A. 2003; Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates. Eur J Clin Nutr 57:548–553 [View Article][PubMed]
    [Google Scholar]
  34. Viswanathan R., Singh A. K., Mukherjee S., Mukherjee R., Das P., Basu S. 2010; An outbreak of neonatal sepsis presenting with exanthematous rash caused by Klebsiella pneumoniae . Epidemiol Infect 139:226–228[PubMed] [CrossRef]
    [Google Scholar]
  35. Waters V., Larson E., Wu F., San Gabriel P., Haas J., Cimiotti J., Della-Latta P., Saiman L. 2004; Molecular epidemiology of Gram-negative bacilli from infected neonates and health care workers’ hands in neonatal intensive care units. Clin Infect Dis 38:1682–1687 [View Article][PubMed]
    [Google Scholar]
  36. Wiener J., Quinn J. P., Bradford P. A., Goering R. V., Nathan C., Bush K., Weinstein R. A. 1999; Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 281:517–523 [View Article][PubMed]
    [Google Scholar]
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