Clostridium Septicum Brain Abscesses in a Premature Neonate

Sadarangani, Sapna P.; Batdorf, Rachel; Buchhalter, Lillian C.; Mrelashvili, Anna; Banerjee, Ritu; Henry, Nancy K.; Huskins, W. Charles; Boyce, Thomas G.

doi:10.1097/inf.0000000000000203

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…NEC and IVH coexistence leads to a more complicated decision-making process because infants with severe IVH who require surgical treatment for PHH with gastrointestinal complications (NEC/ perforated bowel) require a ventriculoatrial rather than ventriculoperitoneal (VP) shunt [ 6 ]. If a VP shunt is utilized in infants with NEC, it can lead to gram-negative ventriculitis with serious effects in the brain [ 23 ]. Improved survival rate in VLBW infants with severe neonatal morbidities, particularly IVH and NEC, is likely to negatively impact long-term neurological outcomes [ 10 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Trends in Preterm Infants of <32 Weeks Gestational Age with Severe Intraventricular Hemorrhage : A 14-Year Single-Center Retrospective Study

Choi

Kim²,

et al. 2023

J Korean Neurosurg Soc

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Objective : Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period.Methods : This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007–2013 (phase I) and 2014–2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed.Results : A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors.Conclusion : In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

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Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Trends in Preterm Infants of <32 Weeks Gestational Age with Severe Intraventricular Hemorrhage : A 14-Year Single-Center Retrospective Study

Choi

Kim²,

et al. 2023

J Korean Neurosurg Soc

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“…Another search on Google Scholar was performed to identify articles published in non-PubMed indexed journals. Seven publications were found, so we finally reviewed 37 texts (20 case reports, 6 case series, 6 7 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 and 11 original articles 2 3 9 38 39 40 41 42 43 44 45 [5 retrospective and 3 epidemiological surveillance studies, 1 prospective observational study, 1 pilot population pharmacokinetic modeling study, and 1 research article]).…”

Section: Methodsmentioning

confidence: 99%

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

Ongun,

Kihtir,

Zarif

et al. 2024

J Pediatr Infect Dis

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Objective Ventriculitis is an example of the increasing global trend in difficult-to-treat infections in neonates caused by pathogens resistant to conventional therapies. This article describes the first use of intravenous and intraventricular tigecycline to treat ventriculitis caused by vancomycin-resistant enterococci in a preterm neonate and systematically review the literature on challenges posed by the definitions, diagnosis, and treatment of neonatal ventriculitis Methods The authors searched PubMed and Internet search engines for “ventriculitis” in the period from 2003 to 2023 restricting the research to “Newborn,” “Human,” “English language,” and “full-text availability.” Results Thirty-seven publications (20 case reports, 6 case series, and 11 research articles) were extracted upon research. Preterm birth, posthemorrhagic ventricular dilatation requiring placement of ventricular access devices, and sepsis preceded neonatal ventriculitis. Infections caused by rare microorganisms, in particular gram-negative bacteria resistant to conventional therapies, predominated in the publications describing the need for a combination of intravenous (IV) and intraventricular (IVT) therapies. Survivors of neonatal ventriculitis developed neurodevelopmental impairments such as hydrocephalus, seizures, motor function, hearing, and vision impairment. Conclusion Clinical suspicion of ventriculitis indicated by subtle signs is key for prompt diagnosis. Effective IV and IVT antibiotics are essential to prevent serious sequelae and mortality. The drug delivery method should be changed if there is no clinical response. This study emphasizes the urgent need for pediatric trials of antibiotics against organisms resistant to other drugs.

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“…Gastrointestinal disease was common, but 6 of these 8 children also had brain involvement, an otherwise rare finding. 14 Five of the children died. All 3 of the survivors underwent surgery; 1 patient had amputation of the arm due to myonecrosis, and 2 patients had drainage of brain abscesses.…”

Section: Discussionmentioning

confidence: 99%

C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

et al. 2017

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Clostridium septicum is an anaerobic bacterium that causes rapidly progressive myonecrosis, bacteremia, and central nervous system infection. It has been reported as a complication of Escherichia coli hemolytic uremic syndrome (HUS) in 8 children worldwide; 5 children died, and the 3 reported survivors had surgically treated disease. We present 3 cases of C septicum complicating HUS in children, including the first 2 reported cases of survival without surgical intervention. All patients presented with classic cases of HUS with initial clinical improvement followed by deterioration. Patient 1 had rising fever, tachycardia, and severe abdominal pain 24 hours after admission. She developed large multifocal intraparenchymal cerebral hemorrhages and died 12 hours later. Autopsy revealed C septicum intestinal necrosis, myonecrosis, and encephalitis. Patient 2 had new fever, increasing leukocytosis, and severe abdominal pain on hospital day 4. She was diagnosed with C septicum bacteremia and treated with metronidazole, meropenem, and clindamycin. Patient 3 had new fever and increasing leukocytosis on hospital day 3; blood cultures grew C septicum, and she was treated with penicillin. Patients 2 and 3 improved rapidly and did not require surgery. C septicum is a potential co-infection with E coli. It thrives in the anaerobic environment of E coli–damaged intestinal mucosa and translocates to cause systemic infection. Fever, tachycardia, a rising white blood cell count, and abdominal pain out of proportion to examination are key findings for which physicians should be vigilant. Timely evaluation by anaerobic blood culture and early initiation of antibiotics are necessary to prevent fatalities.

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Clostridium Septicum Brain Abscesses in a Premature Neonate

Cited by 7 publications

References 9 publications

Morbidity and Mortality Trends in Preterm Infants of <32 Weeks Gestational Age with Severe Intraventricular Hemorrhage : A 14-Year Single-Center Retrospective Study

Morbidity and Mortality Trends in Preterm Infants of <32 Weeks Gestational Age with Severe Intraventricular Hemorrhage : A 14-Year Single-Center Retrospective Study

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

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