Bacterial and fungal viability in the preterm gut: NEC and sepsis

Stewart, Christopher J.; Nelson, Andrew; Scribbins, David; Marrs, Emma C. L.; Lanyon, Clare; Perry, John D.; Embleton, Nicholas D.; Cummings, Stephen; Berrington, Janet

doi:10.1136/archdischild-2012-302119

Cited by 64 publications

(52 citation statements)

References 43 publications

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“…refs. [41][42][43] ), xerophiles (Wallemia sebi and W. muriae), 44 wood decay fungi, 22,45,46 and other organisms whose growth and nutrition requirements preclude any lasting role in the mammalian GI tract.…”

Section: Categories Of Gut Fungimentioning

confidence: 99%

Fungi in the healthy human gastrointestinal tract

2016

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Many species of fungi have been detected in the healthy human gut; however, nearly half of all taxa reported have only been found in one sample or one study. Fungi capable of growing in and colonizing the gut are limited to a small number of species, mostly Candida yeasts and yeasts in the family Dipodascaceae (Galactomyces, Geotrichum, Saprochaete). Malassezia and the filamentous fungus Cladosporium are potential colonizers; more work is needed to clarify their role. Other commonly-detected fungi come from the diet or environment but either cannot or do not colonize (Penicillium and Debaryomyces species, which are common on fermented foods but cannot grow at human body temperature), while still others have dietary or environmental sources (Saccharomyces cerevisiae, a fermentation agent and sometime probiotic; Aspergillus species, ubiquitous molds) yet are likely to impact gut ecology. The gut mycobiome appears less stable than the bacterial microbiome, and is likely subject to environmental factors.

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Section: Categories Of Gut Fungimentioning

confidence: 99%

Fungi in the healthy human gastrointestinal tract

2016

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“…Some of the other potential mechanisms for CMV-associated NEC proposed in this report 15 included increased intestinal mucosal permeability, 28 enhanced proinflammatory cytokine production, [29][30][31] and alterations in the normal interactions between host cells and commensal microorganisms. 32,33 In addition to inducing proinflammatory cytokines, CMV also encodes gene products that modulate the function of host leukocytes, including T cells, neutrophils, and natural killer cells. 34,35 CMV-induced modulation of the host immune response could in turn lead to disruptions in mucosal immune homeostasis, potentiating the development of NEC.…”

Section: Figurementioning

confidence: 99%

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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Human cytomegalovirus (CMV) infection may be acquired in very low birth weight and extremely low birth weight (ELBW) infants from breast milk. The clinical relevance of such infections is uncertain. There is no consensus on whether screening breast milk for CMV, freezing/pasteurizing milk before feeding, or performing virological monitoring on at-risk infants is warranted. We describe an ELBW infant who acquired CMV postnatally from breast milk and developed CMV sepsis syndrome and clinical evidence of necrotizing enterocolitis (NEC) at ∼5 weeks of age. The availability of serial dried blood spots from day of life (DOL) 4 to 21, coincidentally obtained for a metabolic study, provided the novel opportunity to retrospectively test for and quantify the magnitude of CMV DNAemia. DNAemia was present for several weeks before the onset of severe CMV disease, first being noted on DOL 18 and increasing in magnitude daily to 4.8 log10 genomes/mL on DOL 21, approximately 8 days before the onset of abdominal distension and 15 days before the onset of CMV sepsis syndrome and NEC. After surgical resection, supportive care, and ganciclovir therapy, the infant recovered. This case underscores the importance of including CMV infection in the differential diagnosis of sepsis and NEC in premature infants. This case also suggests the value of prospective virological monitoring in at-risk low birth weight and ELBW infants. Future studies should examine the potential utility of preemptive monitoring for, and possibly treatment of, CMV DNAemia in premature infants, which may herald the onset of serious disease.

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“…While a single causative agent is unlikely to be identified, dysbiosis of the gut microbiome preceding NEC may be important [7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Routine Use of Probiotics in Preterm Infants: Longitudinal Impact on the Microbiome and Metabolome

Abdulkadir¹,

Nelson²,

Skeath³

et al. 2016

Neonatology

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Background: Probiotics are live microbial supplements that colonize the gut and potentially exert health benefit to the host. Objectives: We aimed to determine the impact of a probiotic (Infloran®: Lactobacillus acidophilus-NCIMB701748 and Bifidobacterium bifidum-ATCC15696) on the bacterial and metabolic function of the preterm gut while in the neonatal intensive care unit (NICU) and following discharge. Methods: Stool samples (n = 88) were collected before, during, and after probiotic intake from 7 patients, along with time-matched controls from 3 patients. Samples were also collected following discharge home from the NICU. Samples underwent bacterial profiling analysis by 16S rRNA gene sequencing and quantitative PCR (qPCR), as well as metabolomic profiling using liquid chromatography mass spectrometry. Results: Bacterial profiling showed greater Bifidobacterium (15.1%) and Lactobacillus (4.2%) during supplementation compared to the control group (4.0% and 0%, respectively). While Lactobacillus became reduced after the probiotic had been stopped, Bifidobacterium remained high following discharge, suggestive of successful colonisation. qPCR analysis showed a significant increase (p ≤ 0.01) in B. bifidum in infants who received probiotic treatment compared to controls, but no significant increase was observed for L. acidophilus (p = 0.153). Metabolite profiling showed clustering based on receiving probiotic or matched controls, with distinct metabolites associated with probiotic administration. Conclusions: Probiotic species successfully colonise the preterm gut, reducing the relative abundance of potentially pathogenic bacteria, and effecting gut functioning. Bifidobacterium (but not Lactobacillus) colonised the gut in the long term, suggesting the possibility that therapeutically administered probiotics may continue to exert important functional effects on gut microbial communities in early infancy.

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Bacterial and fungal viability in the preterm gut: NEC and sepsis

Abstract: Total and viable communities differ in preterm infants, and non-viable fungal species are present in infants on fungal prophylaxis. Exploration of viability and non-bacterial contributors to the total community may increase understanding of NEC and sepsis.

Cited by 64 publications

References 43 publications

Fungi in the healthy human gastrointestinal tract

Fungi in the healthy human gastrointestinal tract

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Routine Use of Probiotics in Preterm Infants: Longitudinal Impact on the Microbiome and Metabolome

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