Distinctive Distribution of Pathogens Associated With Peritonitis in Neonates With Focal Intestinal Perforation Compared With Necrotizing Enterocolitis

Abstract

ABSTRACT.Objective. Candida and coagulase-negative staphylococci are emerging pathogens associated with focal intestinal perforation (FIP) and necrotizing enterocolitis (NEC) in neonates. The objective of this study was to determine whether there are significant differences in the predominant pathogens in culturepositive cases of peritonitis associated with FIP compared with NEC in neonates.Methods. A retrospective cross-sectional study was conducted of neonates with peritoneal culture-positive peritonitis associated with FIP or NEC over a 12-year study period (1989 -2000). Cases with peritonitis were identified from a microbiology database. NEC was defined by radiologic evidence of pneumatosis intestinalis or portal venous gas or by pathology reports or surgical operative notes describing large areas of transmural bowel necrosis. FIP was defined as a <1-cm intestinal perforation surrounded by otherwise normal tissue in the absence of NEC.Results. Thirty-six cases of FIP were compared with 80 cases of NEC. Birth weight and gestational age were significantly lower in infants with FIP compared with NEC. Age at intestinal perforation and case fatality rates were similar between FIP and NEC. There were striking differences in the distribution of predominant pathogens associated with peritonitis in NEC and FIP cases. Enterobacteriaceae were present in 60 (75%) of 80 NEC cases compared with 9 (25%) of 36 FIP cases. In contrast, Candida species were found in 16 (44%) of 36 FIP cases compared with 12 (15%) of 80 NEC cases, and coagulasenegative staphylococci were present in 18 (50%) of 36 FIP cases versus 11 (14%) of 80 NEC cases. There were no significant differences between FIP and NEC cases for the presence of Enterococcus species (28% vs 23%) or anaerobes (3% vs 6%). Stratified analysis for birth weight <1200 g found similar significant differences in the predominant pathogens for FIP (n ‫؍‬ 29) and NEC (n ‫؍‬ 38).

A Critical Role for TLR4 in the Pathogenesis of Necrotizing Enterocolitis by Modulating Intestinal Injury and Repair

“…A specific role for Gram-negative bacterial LPS in the pathogenesis of NEC is supported by the results of studies performed in newborn rats and piglets in which the oral or i.v. administration of LPS in combination with hypoxic treatment was associated with changes in the intestine resembling NEC (62)(63)(64), and the finding that high levels of pathogens are detected in the peritoneal cavities of neonates with NEC (65). On the basis of findings, we sought to define a role for the LPS receptor, TLR4, in the pathogenesis of NEC.…”

Anaerobic Antimicrobial Therapy After Necrotizing Enterocolitis in VLBW Infants

“…8,11,12 A wide range of pathogens are associated with NEC, including aerobic and anaerobic bacteria. 10,[13][14][15][16][17][18][19] Therapy for NEC includes broad-spectrum antibiotics with coverage of bacteria from the intestinal tract. In a small cohort of infants with NEC, a randomized controlled trial with 42 infants observed no difference in mortality or intestinal perforation in those who received an antibiotic regimen of ampicillin, gentamicin, and clindamycin compared with those who received only ampicillin and gentamicin.…”

“…A wide range of pathogens are associated with NEC. 15 Several case series of infants with NEC have reported the presence of anaerobic bacteria, including Clostridium perfringens and Bacteroides fragilis, in the blood or peritoneal fluid. 17,19,[32][33][34][35][36] A study including 25 infants with NEC showed that infants who had Clostridium spp.…”

Anaerobic Antimicrobial Therapy After Necrotizing Enterocolitis in VLBW Infants

“…A wide range of pathogens are associated with NEC. 15 Several case series of infants with NEC have reported the presence of anaerobic bacteria, including Clostridium perfringens and Bacteroides fragilis, in the blood or peritoneal fluid. 17,19,[32][33][34][35][36] A study including 25 infants with NEC showed that infants who had Clostridium spp.…”