Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study

Auriti, Cinzia; Rose, Domenico Umberto De; Santisi, Alessandra; Martini, Ludovica; Ronchetti, Maria Paola; Ravà, Lucilla; Antenucci, Valeria; Bernaschi, Paola; Serafini, Lisa; Catarzi, Serena; Fiorini, Patrizio; Betta, Pasqua; Scuderi, Maria Grazia; Benedetto, Vincenzo Di; Ferrari, Stefania; Maino, Marzia; Cavigioli, Francesco; Cocchi, Ilaria; Giuffrè, Mario; Bonanno, Elvira; Tzialla, Chryssoula; Bua, Jenny; Pugni, Lorenza; Torre, Benedetta Della; Nardella, Giovanna; Mazzeo, Danila; Manzoni, Paolo; Capolupo, Irma; Atti, Marta Ciofi Degli; Dotta, Andrea; Stronati, Mauro; Raponi, Massimiliano; Mosca, Fabio; Bagolan, Pietro

doi:10.1016/j.jhin.2022.09.018

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…Recently, nearly half of blood infections worldwide occurred in children; notably, almost 2.9 million children younger than five years have died from sepsis [ 2 , 3 , 4 ]. Globally, gram-negative bacteria accounted for a majority of pathogens in children with BSIs, followed by gram-positive bacteria and fungi [ 5 , 6 , 7 ]. Generally, the most common gram-negative bacterial isolates were Klebsiella spp., Escherichia coli ( E. coli ), Acinetobacter baumannii ( A. baumannii ), and Pseudomonas aeruginosa ( P. aeruginosa ), and the most frequent gram-positive bacterial isolates were Staphylococcus aureus ( S. aureus ), Group B Streptococcus (GBS), Coagulase-negative Staphylococci (CoNS), and Enterococcus spp.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

et al. 2023

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Droplet digital PCR (ddPCR) recently has been shown to be a potential diagnostic tool for adults with bloodstream infections (BSIs); however, its application in children remains obscure. In this study, 76 blood samples of children with suspected BSIs were synchronously detected by traditional blood cultures (BCs) and ddPCRs. Our team validated the diagnostic performance of ddPCR including sensitivity, specificity, and positive and negative predictive values. The 76 pediatric patients from the hematology department (67.1%), the pediatric intensive care unit (PICU, 27.6%), and other departments (5.2%) were enrolled. The positive rate of ddPCR results was 47.9%, whereas that for BC was 6.6%. In addition, the time consumption of ddPCR was shorter, only for 4.7 ± 0.9 h, in comparison with the detection timing of BC (76.7 ± 10.4 h, p < 0.01). The levels of agreement and disagreement between BC and ddPCR were 96.1% and 4.2%, and the negative agreement reached 95.6%. The sensitivity of ddPCR was 100%, with corresponding specificities ranging from 95.3 to 100.0%. In addition, a total of nine viruses were identified by ddPCR. In China, the multiplexed ddPCR first could be a tool for the rapid and accurate diagnosis of children with suspected BSIs and can be an early indicator of the possibility of viraemia in children with immunosuppression.

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Section: Introductionmentioning

confidence: 99%

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

et al. 2023

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“…In the current study, it was determined that C. albicans was significantly more common particularly in infants born with NVD. Auriti et al [ 19 ] showed an increase of approximately 70% in C. albicans in vaginal candida colonization during pregnancy. This increased colonization is thought to play a role in obstetric tears.…”

Section: Discussionmentioning

confidence: 99%

Candidal Infections in the Neonatal Intensive Care Unit: A Retrospective Observational Study

Tunç¹

2023

Sisli Etfal

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Objectives The aims of this study were to evaluate the demographic characteristics, risk factors, mortality rates, and laboratory findings of infants with fungal sepsis in the Neonatal Intensive Care Unit (NICU). Methods This retrospective multicenter study included patients in NICU with Candida spp isolated in blood cultures between November 01, 2019, and September 01, 2022. The patients were evaluated in two groups as Group 1 infants with Candida albicans and Group 2 infants with Candida non-albicans positive blood cultures. Results Candida infection was detected in blood cultures in 57 of 3450 patients admitted to the NICU. A total of 57 infants included in the study. Candida infection was determined 1.6% of infants in the study population, and 57% of them were extremely pre-term infants. There was no significant difference between the two groups in terms of laboratory data. Normal vaginal birth was determined at a higher rate in Group 1. In Group 2, length of hospital stay, duration of total parenteral nutrition (TPN), and mechanical ventilation (MV) were determined to be longer. The mortality due to Candida fungemia was determined as 35%, and of these patients, 65% had an additional medical condition. Conclusion In accordance with the literature, this study showed that prolonged MV and longer TPN increased the incidence of fungal sepsis. Therefore, to decrease the fungal sepsis rate of NICU, shortening the hospital stay and effective screening programs are recommended.

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“…The resumption of feeding preterm neonates after surgery is a minefield where the duration of fasting and the type of feeding can have both advantages and disadvantages. Clearly, the consequences of delayed enteral feeding include oral aversion, gastrointestinal effects (mucosal villous atrophy, dysbiosis, small bowel bacterial overgrowth, and intestinal dysmotility), dependence on parenteral nutrition, and intestinal failure-associated liver disease, as well as a higher risk of bloodstream infections due to the prolonged indwelling time of central venous catheters [ 32 , 33 ].…”

Section: Early Enteral Feeding and Fast Advancementmentioning

confidence: 99%

“…Frequent peripheral intravenous site rotations are required (usually every 48–72 h), and this should be considered. Administration through peripheral venous access also simplifies the management of the newborn patient to reduce the length of stay of the central venous catheters, which can lead to greater risks and complications such as infections and thrombosis [ 33 , 79 , 80 ].…”

Section: Peripheral Parenteral Nutritionmentioning

confidence: 99%

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

De Rose,

Lapillonne,

Iacobelli

et al. 2024

Nutrients

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The nutrition of preterm infants remains contaminated by wrong beliefs that reflect inexactitudes and perpetuate old practices. In this narrative review, we report current evidence in preterm neonates and in preterm neonates undergoing surgery. Convictions that necrotizing enterocolitis is reduced by the delay in introducing enteral feeding, a slow advancement in enteral feeds, and the systematic control of residual gastric volumes, should be abandoned. On the contrary, these practices prolong the time to reach full enteral feeding. The length of parenteral nutrition should be as short as possible to reduce the infectious risk. Intrauterine growth restriction, hemodynamic and respiratory instability, and patent ductus arteriosus should be considered in advancing enteral feeds, but they must not translate into prolonged fasting, which can be equally dangerous. Clinicians should also keep in mind the risk of refeeding syndrome in case of high amino acid intake and inadequate electrolyte supply, closely monitoring them. Conversely, when preterm infants undergo surgery, nutritional strategies are still based on retrospective studies and opinions rather than on randomized controlled trials. Finally, this review also highlights how the use of adequately fortified human milk is strongly recommended, as it offers unique benefits for immune and gastrointestinal health and neurodevelopmental outcomes.

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Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study

Cited by 5 publications

References 35 publications

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

Candidal Infections in the Neonatal Intensive Care Unit: A Retrospective Observational Study

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

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