Features of Microbiota in Newborns in Critical Condition at Admission to the Intensive Care Unit of a Specialized Hospital

BACKGROUND: Infectious complications related to prolonged epidural and peripheral regional anesthesia are quite rare. However, this does not exclude the necessity of strict adherence to measures aimed at preventing microbial colonization of catheters for regional anesthesia. Microbial colonization of the catheter is not always accompanied by the development of infectious complications but increases the likelihood of their occurrence. AIM: To determine the frequency of colonization, the qualitative and quantitative composition of the microflora depending on the various methods of fixing of the catheter and the duration of its use. MATERIALS AND METHODS: 76 patients from 2 to 18 years old with prolonged epidural or peripheral anesthesia were included in an comparative, prospective, randomized, single-center study. Patients were divided into the groups according to the method of catheter fixation - adhesive sticker (AS), adhesive sticker and antimicrobial coating Desitol B (AS+D) and tunneling (T). Determination of microbial contamination of catheters was carried out using classical bacteriological studies. RESULTS: None of the 76 patients had signs of a local or systemic infection. The difference in the frequency of colonization between the AS and T groups was statistically significant: 2 (1, n = 54) = 5.5381 (p = 0.018), between the AS and AS+D groups it was not significant. The relative risk of colonization of the skin of the catheter with adhesive fixation was 2.14 times higher than with catheter tunneling: RR = 2.14, p = 0.05 (95% CI 1.04.49). In the AS+D group, colonization of both the skin and the inner part of the catheter was observed significantly earlier than in the T group: skin part: U = 5.5; Ucr = 8 (p = 0.02); inner part: U = 5.5; Ucr = 6 (p = 0.04). The growth of Staphylococcus epidermidis (48.3%) and Staphylococcus aureus (20.7%) was fixed mainly when positive results of microbiological culture takes place. CONCLUSIONS: Tunneling is the preferred method of fixation of the catheter when the postoperative pain relief period is more than 3 days.

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Predictors of early-onset neonatal infections (review)

Alexandrovich,

Ivanov,

Pavlovskaya

et al. 2024

Pediatr (SPb)

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Infections of the early neonatal period and neonatal sepsis are the most common cause of critical condition, various complications and unfavorable outcome of the disease, both in the early and distant periods, but there are currently no reliable criteria for diagnosis, which makes it difficult to recognize the infectious process early. Based on the results of numerous studies, it was found that the clinical blood test has extremely low clinical value for the diagnosis of infections and early neonatal sepsis. It was found that the concentration of C-reactive protein in the blood rises 10–12 hours after the appearance of the first clinical manifestations of infection and peaks 48 hours later. An increase in C-reactive protein to 20 mg/L 48 hours after birth is possible even in newborns without infection, so its use as a marker of infections of the early neonatal period is very difficult. The threshold for C-reactive protein concentration in the first days of life is 10 mg/L. Premature babies have lower C-reactive protein values compared to full-term newborns. Increasing the concentration of procalcitonin, as well as C-reactive protein, immediately after birth is physiological, which limits their diagnostic value in the first 2–4 days of life. The procalcitonin concentration study is more justified for making an informed decision to discontinue antibacterial therapy. Presepsin is one of the earliest markers of a severe course of infections in newborns, since its concentration does not depend on the term of gestation. The level of N-terminal pro-BNP can be used as a marker of cardiovascular dysfunction, an increase in its level is associated with the severity of the infectious process and fatal outcome. A universal marker of infections of the early neonatal period and sepsis in newborns is currently absent, which indicates the need for a thorough assessment of all available clinical and laboratory tests over time.

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Features of Microbiota in Newborns in Critical Condition at Admission to the Intensive Care Unit of a Specialized Hospital

Cited by 5 publications

References 19 publications

Cardiac dysfunction in newborns with intraamniotic infection

Cardiac dysfunction in newborns with intraamniotic infection

Comparative study of microbial colonization of catheters for prolonged regional anesthesia when using different fixation methods

Predictors of early-onset neonatal infections (review)

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