Infections in gastroschisis: organisms and factors

Abstract

This study aimed to define the incidence, causative organisms and predisposing factors leading to infection related morbidity in newborns with gastroschisis. All gastroschisis patients admitted over the 5-year period (1999-2004) were retrospectively reviewed. Surveillance samples, wound, blood, urine and fecal cultures were analyzed. Duration of total parenteral nutrition, antibiotic therapy, feeding regimes and demographic data were also analyzed. Multiple logistic regression was employed using the SPSS system and p < 0.05 was considered as significant. Seventy-two neonates were identified with 53% having abnormal gut carriage mostly due to Enterobacter and Klebsiella. Wound infection occurred in 20% of cases. Abnormal gut carriage predisposed to the development of wound infection. Line sepsis occurred in 21% of neonates. Endogenous coagulase negative Staphylococcus caused 74% of septic episodes. There was no correlation between abnormal gut carriage and the development of line sepsis. Overall survival was 96%. The cause of infections in gastroschisis patients appears to be multifactorial. A multidisciplinary team can play an important role in reducing the incidence of infections. Strict aseptic protocols and auditing practice can be the invaluable tools in decreasing morbidity rates.

Infectious complications in the management of gastroschisis

“…CRI complicated the hospital course in 14% of our cases, a rate that is less than recent single-institution reports from Thailand and Great Britain [10,11]. While the method of catheter placement did not affect the rate of CRI, the duration of catheter placement did-a finding that is consistent with previous reports in the literature [12].…”

“…We also observed that pre-term neonates did not experience a greater frequency of infectious complications, a finding contrary to a previous publication on the subject [26]. Our data suggested no difference in infectious complications between genders, in contradistinction to a recent single institution that reported an unexplained increase in infections in male patients [11]. We noted that a neonate with a high GPS score was at a significantly increased risk of developing an infectious complication.…”

Identifying strategies to decrease infectious complications of gastroschisis repair

“…Gastroschisis patients are often delivered preterm, either electively owing to preterm labor or owing to complications of pregnancy. Various outcomes have been reported in the literature related to this topic, and the results have been mixed [1,2,7,10,[12][13][14][15]. There are some reports of worse outcomes with early delivery, including an increased risk of infectious complications and poorer long-term neurodevelopmental outcomes [8,12].…”

“…Gorra found that gastroschisis patients experienced poorer neurodevelopmental outcomes if delivered prior to 37 weeks [12]. In studies that evaluated infectious complications of gastroschisis, Baird et al found no association between gestational age and risk of infection [7]. Conversely, Wilson reported that preterm gastroschisis patients experienced not only longer TPN usage and increased length of stay but also an increased rate of acquired sepsis [15].…”

“…Of those studies that have, infections were examined over the first inpatient experience of patients [7,8]. We limited our focus to infectious complications in the first 60 days to eliminate the inclusion of infectious complications that are an effect of prolonged NICU admission so as to include only infections developed secondary to gastroschisis.…”