Do isolates from pharyngeal and rectal swabs match blood culture bacterial pathogens in septic VLBW infants? A pilot, cross-sectional study

Abstract

Serial body site swabbing is used to monitor horizontal spread of aggressive bacterial species in the neonatal intensive care unit (NICU). Since colonization/carriage is thought to precede systemic infection, one might expect to retrieve colonizing pathogens from blood cultures. This hypothesis, however, has not been fully investigated in very low birth weight (VLBW) infants that are at high sepsis' risk. The primary outcome was, in a population of VLBW infants with late-onset sepsis, the matching between blood culture results and pathogens isolated from rectal and nose/pharyngeal surveillance swabs in the preceding 2 weeks. The secondary outcomes were the site of swabbing and time interval from colonization to blood culture positivity. Out of 333 VLBW neonates, 80 (24%) were diagnosed with bacterial sepsis. In 46 (57%) neonates, the blood culture showed the same pathogen species cultured from a swab. Of these, 30 were isolated from infants with both body sites colonized with an average time interval of 3.5 days; 2/16 were isolated from rectal swabs and 14 /16 from nose/pharyngeal samples. Conclusion: Our data show a fair correspondence between bacteria colonizing the nasopharynx and/or the rectum and pathogens later isolated from blood cultures. This association depends on the swabbing site, number of sites, and pathogen species. Although these data constitute valuable results, they are not sufficient for providing the sole base of a thoughtful clinical decision.

Pentaglobin (immunoglobulin M-enriched immunoglobulin) as adjuvant therapy for premature and very low-birth-weight neonates with sepsis

“…[ 6 ] The newborn immune system's immaturity, slow production of endogenous immunoglobulin, absence of maternal transplacental transport of IgG, and defects in the complement system all support the use of effective immunotherapy as adjuvant treatment for neonatal sepsis. [ 7 ] Therefore, Pentaglobin gained great interests in clinical work as adjuvant therapies. [ 8 ] Immunoglobulin is one of the main interconnectable components of the immune system that permit a host to defend against microbial infection.…”

Do Not Act Fast and Furious

“…But: the knowledge about the individual colonization of a preterm infant with MDR pathogens may guide the decision of empirical treatment in case of LOS. 5 In a recent survey, 94% of neonatologists in Germany considered this information of relevance with regard to the antibiotic treatment. 6 Inadequate empiric antibiotic treatment of LOS (in particular, in case of a Gram-negative pathogen) may cause deleterious outcomes.…”