Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

Abstract

Twenty percent of very-low-birth-weight (<1500 g) preterm infants experience a serious systemic infection, and despite advances in neonatal intensive care and antimicrobials, mortality is as much as threefold higher for these infants who develop sepsis than their counterparts without sepsis during their hospitalization. Outcomes may be improved by preventative strategies, earlier and accurate diagnosis, and adjunct therapies to combat infection and protect the vulnerable preterm infant during an infection. Earlier diagnosis on the basis of factors such as abnormal heart rate characteristics may offer the ability to initiate treatment prior to the onset of clinical symptoms. Molecular and adjunctive diagnostics may also aid in diagnosing invasive infection when clinical symptoms indicate infection but no organisms are isolated in culture. Due to the high morbidity and mortality, preventative and adjunctive therapies are needed. Prophylaxis has been effective in preventing early-onset group B streptococcal sepsis and late-onset Candida sepsis. Future research in prophylaxis using active and passive immunization strategies offers prevention without the risk of resistance to antimicrobials. Identification of the differences in neonatal intensive care units with low and high infection rates and implementation of infection control measures remain paramount in each neonatal intensive care unit caring for preterm infants

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

“…Dentre eles estão o leucograma e os marcadores séricos de reação inflamatória, como a interleucina-8, a proteína C-reativa (PCR), a interleucina-6 (IL-6), o fator de necrose tumoral-alfa (TNF-α) e a procalcitonina 5,[8][9][10] .…”

The changing spectrum of neonatal infectious disease

“…The primary organisms responsible for EOS in VLBW may vary at different centers and over time, but remain primarily E. coli, GBS and CONS. 8,46,47 Data compiled from these and additional studies 34,[47][48][49] and reviewed 8 show that in sepsis that presents in <72 h, about 61% were caused by Gram-negative organisms, with an associated mortality of 41, and 37% were caused by Gram-positive organisms, with an associated mortality of 26%. Fungal infections with Candida albicans accounted for only 2.4% of EOS.…”

“…CONS are now the most prevalent infecting organism in the neonatal setting, owing this distinction to the late-onset infection rate in neonatal intensive care units. [8][9][10] Joining these organisms are E. coli, and multidrug-resistant Gram-negative organisms including Pseudomonas, Klebsiella and the fungi. [3][4][5][6][7][8][9][10][11][12] Although systemic infection of the term newborn indeed occurs, severe sepsis is now primarily a complication of preterm delivery.…”

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

“…98 Neonatal practices that may reduce the risks of invasive candidiasis include limited use of broad-spectrum antimicrobials in hosts with documented resistant pathogens, use of an aminoglycoside instead of a cephalosporin for empiric therapy when meningitis or antimicrobial resistance is not suspected, limitation of postnatal steroid use in VLBW infants, early enteral feeding, and the establishment of the neonatal gut microbiome with human milk feeding. 24,99 Infection prevention practices in the NICU, including the utilization of trained teams with standardized practices for the insertion and care of CVCs, have been shown to reduce the incidence of catheter-related infections.…”