Sepsis Neonatorum

Wilson, Holly; Eichenwald, Heinz F.

doi:10.1016/s0031-3955(16)33025-5

Cited by 60 publications

(30 citation statements)

References 24 publications

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“…Tetracycline-resistant and -susceptible strains were screened for the carriage of a range of virulence factor genes shown to be of importance for extra-intestinal infections, such as P, type 1 and S fimbriae, aerobactin and hemolysin (36,37). As shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…E. coli strains colonizing the large intestine vary in their carriage of genes encoding adhesins, iron-trapping compounds and hemolysin (23). These are virulence factors known to enable bacteria to cause extraintestinal infections, such as urinary tract infection and septicemia (36,37). Some of these factors, especially P fimbriae, also contribute to persistence of E. coli in the colon (23).…”

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confidence: 99%

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Tetracycline Resistance in Escherichia coli and Persistence in the Infantile Colonic Microbiota

Karami

Nowrouzian

Adlerberth

et al. 2006

Antimicrob Agents Chemother

105

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The ecological impact of antibiotic resistance in the absence of selective pressure has been poorly studied. We assessed the carriage of tetracycline resistance genes, persistence in the microbiota, fecal population counts and virulence factor genes in 309 commensal, intestinal Escherichia coli strains obtained from 128 Swedish infants followed during the first year of life with regular quantitative fecal cultures. No infant was given tetracycline, but 25% received other antibiotics. Tetracycline resistance was identified in 12% of strains, all of which carried either tet(A) (49%) or tet(B) (51%) genes. Resistance to other antibiotics occurred in 50% of tet(A)-positive strains, 42% of tet(B)-positive strains and 13% of tetracycline-sensitive strains. However, colonization with tetracycline-resistant strains was unrelated to treatment with antibiotics. Strains that were tet(B)-or tet(A)-positive carried the genes for P fimbriae and aerobactin, respectively, more often than susceptible strains. Tetracycline-resistant and -susceptible strains were equally likely to persist among the intestinal microbiota for >3 weeks and had similar population numbers. However, when a resistant strain and a susceptible strain colonized a child simultaneously, the resistant variety showed lower counts (P ‫؍‬ 0.03). In cases of long-term colonization by initially tetracycline-resistant E. coli strains, loss of tet genes occurred in 3 of 13 cases with variable effects on population counts. The results indicate that there is limited pressure against the carriage of tet genes in the infantile gut microbiota even in the absence of antibiotics. Resistant strains may possess colonization factors that balance the cost of producing resistance elements.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Tetracycline Resistance in Escherichia coli and Persistence in the Infantile Colonic Microbiota

Karami

Nowrouzian

Adlerberth

et al. 2006

Antimicrob Agents Chemother

105

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“…4 Indeed, several authors have suggested that multiple site blood cultures may be more efficacious in diagnosing neonatal sepsis. 2,[4][5][6][7] In addition, the recommendations for older children and adults are also to obtain blood cultures from at least two sites. 4,[8][9][10] To date, however, there is no prospective trial that has been performed which has evaluated the role of multiple site blood cultures in the detection of early-and late-onset sepsis in the neonates.…”

Section: Introductionmentioning

confidence: 99%

A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis

et al. 2005

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Background: The optimal number of blood cultures needed to document sepsis in an ill neonate has undergone little critical evaluation. Multiple site cultures may improve pathogen detection if intermittent bacteremia occurs, or if a low density of bacteria is present in the blood. We hypothesized, however, that bacterial clearance is slower and bacteremia more continuous in septic neonates, so that a single site blood culture should be sufficient to accurately document true septicemia.Objective: To determine the need for multiple site blood cultures in the evaluation of neonates for sepsis.Design/Methods: Clinical data were prospectively collected for 216 neonates who had 269 pairs of blood cultures taken from two different peripheral sites for the evaluation of possible sepsis. A minimum of 1 ml of blood was obtained from the two peripheral sites within 15-30 min of each other. Based on prior retrospective data, we determined that 203 infants would need to have two site blood cultures to demonstrate a significant improvement in pathogen detection at an alpha of 0.05 and a beta of 0.20 (80%) power.Results: A total of 186 culture pairs were taken for evaluation of earlyonset sepsis in 186 neonates, while 83 pairs were drawn for evaluation of late-onset sepsis in 43 neonates. In all, 21 neonates from the late-onset group were evaluated more than once, and 12 neonates were evaluated for both early-and late-onset sepsis. In all, 20 (9.2%) of 216 neonates had 22 episodes of culture-proven sepsis at a median age of 18 days. All neonates with positive cultures had the same organism with a similar sensitivity pattern obtained from the two different peripheral sites. The other 196 study neonates had negative blood cultures from both sites. The single episode of early-onset sepsis was caused by Listeria monocytogenes, while all remaining episodes were late-onset with the following organisms: Staphylococcus epidermidis (7), methicillin-resistant Staphylococcus aureus (MRSA) (3), combined MRSA and Candida albicans (2), Candida albicans alone (2), late-onset Group B b-hemolytic Streptococcus (GBS) (2), Klebsiella pneumoniae (2), Enterococcus fecalis (1), Escherichia coli (1), and Serratia marcescens (1). Since no infant grew organisms from only one of the two sites, the data indicate that the diagnosis of sepsis would have been made correctly in all infants with a single site culture. Conclusions:Two site blood cultures for the initial evaluation of neonatal sepsis do not have a better yield in pathogen detection. Sepsis in neonates can be detected with no loss of accuracy with a single site blood culture with blood volume of X1 ml.

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“…This recommendation may lead to the occasional treatment of infants less than 2 months of age with this combination, although H. influenzae type b is infrequently isolated from infants in this age group with meningitis (1,15,19,20).…”

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confidence: 99%

Antagonism of ampicillin and chloramphenicol for meningeal isolates of group B streptococci

Weeks¹,

Mason²,

Baker³

1981

Antimicrob Agents Chemother

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The increasing prevalence of ampicillin-resistant Haemophilus influenzae type b has led to the recomxniendation that ampicillin and chloramphenicol be given as the initial therapy for suspected bacterial meningitis in infants and children. However, during the first 2 months of life, H. influenzae type b is a rare cause of meningitis, whereas group B streptococcus is the most frequently isolated agent. Since ampicillin and chloramphenicol have been shown to be antagonistic for other streptococci, an in vitro study of their effect on group B streptococci was performed. The effect of ampicillin and chloramphenicol, alone and in combination, on 18 meningeal isolates was determined for 2 different inocula of group B streptococci, using microtiter broth dilution and growth kinetic assays. Isoboles, fractional lethal concentration indices, or both indicated antagonism for all strains. Growth kinetic assays for two representative strains demonstrated inhibition of the early bactericidal activity of ampicillin by chloramphenicol. These findings of in vitro antagonism suggest that this combination may be contraindicated for the treatment of infants with group B streptococcal meningitis.Because of the emergence of ampicillin-resistant Haemophilus influenzae type b strains, a combination of ampicillin with chloramphenicol has been recommended since 1974 as initial antibiotic therapy for bacterial meningitis beyond the neonatal period (2). This recommendation may lead to the occasional treatment of infants less than 2 months of age with this combination, although H. influenzae type b is infrequently isolated from infants in this age group with meningitis (1,15,19,20).In vitro and some in vivo studies have indicated that chloramphenicol in combination with a penicillin is antagonistic for some bacterial species. For example, interference with the early bactericidal effect of penicillin was reported by Wallace et al. (17) in an animal model of pneumococcal meningitis. Similarly, Mathies et al. (13) observed an increased case-fatality ratio among children and adults with bacterial meningitis who were treated with the combination of ampicillin, chloramphenicol, and streptomycin compared with those who were treated with ampicillin alone.Because group B streptococci (GBS) are the single most frequent agents isolated in our medical center from infants less than 2 months of age with bacterial meningitis (1), we believed it important to evaluate the in vitro effect of ampicillin and chloramphenicol against several meningeal isolates. MATERIALS AND METHODSBacterial isolates. Eighteen cerebrospinal fluid (CSF) isolates of GBS from infants <2 months of age were serotyped by the capillary precipitin method of McCarty and Lancefield (14). The serotype distribution of these strains was representative of that reported among neonatal meningeal isolates (18)

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Sepsis Neonatorum

Cited by 60 publications

References 24 publications

Tetracycline Resistance in Escherichia coli and Persistence in the Infantile Colonic Microbiota

Tetracycline Resistance in Escherichia coli and Persistence in the Infantile Colonic Microbiota

A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis

Antagonism of ampicillin and chloramphenicol for meningeal isolates of group B streptococci

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