Late onset sepsis and intestinal bacterial colonization in very low birth weight infants receiving long-term parenteral nutrition

Abstract

Introduction:The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). Methods: Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. Results: 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. Conclusions: In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

“…The VLBW infants using parenteral nutrition, who are strongly exposed to the NICU environment, to the colonization of the non-inserted distal catheter tip due to handling by the health team professionals and contact with the microbiota of their own skin, represent important risk factors, as mentioned in different studies that observed high rates of blood infections associated with central venous catheters. (4,8,13,(17)(18)(19) In this study, the arterial umbilical catheter was 8.5 times more associated with the occurrence of late sepsis, in line with other association studies between hospital infections and venous catheters. (17,19) The blood infections related to the use of venous catheter are reported to be the most common at the NICU, and mostly result from technical errors in the installation and care for the insertion site and in catheter handling.…”

“…(4,8,13,(17)(18)(19) In this study, the arterial umbilical catheter was 8.5 times more associated with the occurrence of late sepsis, in line with other association studies between hospital infections and venous catheters. (17,19) The blood infections related to the use of venous catheter are reported to be the most common at the NICU, and mostly result from technical errors in the installation and care for the insertion site and in catheter handling. (20) The occurrence of late neonatal sepsis and its relation with the NICU environment and the invasive procedures the infants are submitted to have been widely discussed in studies undertaken in the large urban centers of Brazil and internationally.…”

“…(18) Venous accesses stand out as HAI and associated with cases of sepsis. (4,12,(16)(17)(18) In this study, the birth weight (p= 0.03), peripheral venous access (p= 0.05) and arterial umbilical catheter (p= 0.10) showed higher significance rates with p< 0.20, being included in the logistic regression model adjusted to gesta- Adjusted model for gestational age and gender tional age and gender. In the final model, however, birth weight and arterial umbilical catheter remained as independent factors, the latter being an important determinant in the occurrence of late sepsis.…”

“…(5,7,16,17) At the NICU where the study was developed, figures for late sepsis were less expressive.…”

“…(20) The occurrence of late neonatal sepsis and its relation with the NICU environment and the invasive procedures the infants are submitted to have been widely discussed in studies undertaken in the large urban centers of Brazil and internationally. (5,7,8,17,19,21) This concern targets improvements in the quality of care for low-weight infants, reducing the sequelae of clinical problems provoked by intense infection processes and death rates.…”