Neonatal escherichia coli septicemia—bacterial counts in blood

Dietzman, Dale E.; Fischer, Gerald W.; Schoenknecht, Fritz D.

doi:10.1016/s0022-3476(74)80308-2

Cited by 232 publications

(133 citation statements)

References 6 publications

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“…On the basis of quantitative blood culture data from the 1970's, it has been shown that 80% of infected newborns with early-onset sepsis had high loads of Escherichia coli. 20,23 Similar observations were made with reference to late onset coagulase-negative Staphylococcal sepsis as well in a study of 787 neonatal blood culture specimens which showed that no cases of coagulase-negative septicemia were associated with counts of <5 CFU/ml, 16,24 in contrast to the concentration of microorganisms of <1 CFU/ml in 50% of adult bloodstream infections. 16,25 Results of our current prospective study indicate that two site blood cultures for the initial evaluation of neonatal sepsis do not improve pathogen detection.…”

Section: Discussionsupporting

confidence: 66%

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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Section: Discussionsupporting

confidence: 66%

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

et al. 2005

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“…23 Furthermore, up to 25% of infants with sepsis have low colony count bacteremia (≤4 CFU/mL), and two-thirds of infants younger than 2 months of age have colony counts <10 CFU/mL. 24,25 Neal et al demonstrated that more than half of blood specimens inoculated into the aerobic bottle were less than 0.5 mL. 26 A study by Connell et al indicated that blood cultures with an adequate volume were twice as likely to yield a positive result.…”

Section: Blood Culturementioning

confidence: 99%

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

693

433

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With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics

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“…High-level bacteraemia precedes the development of ExPEC neonatal meningitis (47,48). VFs that contribute to the ability of ExPEC to maintain high-level bacteraemia include those that allow it subvert the host immune response, e.g.…”

Section: Neonatal Meningitis-associated Vfsmentioning

confidence: 99%

Extra-intestinal pathogenic Escherichia coli (ExPEC): Disease, carriage and clones

Dale

Woodford

2015

Journal of Infection

165

132

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Extra-intestinal pathogenic E. coli (ExPEC) have a complex phylogeny, broad virulence factor (VF) armament and significant genomic plasticity, and are associated with a spectrum of host infective syndromes ranging from simple urinary tract infection to life-threatening bacteraemia. Their importance as pathogens has come to the fore in recent years, particularly in the context of the global emergence of hyper-virulent and antibiotic resistant strains.Despite this, the mechanisms underlying ExPEC transmission dynamics and clonal selection remain poorly understood. Large-scale epidemiological and clinical studies are urgently required to ascertain the mechanisms underlying these processes to enable the development of novel evidence-based preventative and therapeutic strategies. In the current review, we provide a concise summary of the methods utilised for ExPEC phylogenetic genetic delineation before exploring in detail the associations between ExPEC VFs and site-specific disease. We then consider the role of ExPEC as an intestinal colonist before outlining known associations between ExPEC clonal variation, specific disease syndromes and antibiotic resistance.

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Neonatal escherichia coli septicemia—bacterial counts in blood

Cited by 232 publications

References 6 publications

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

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

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Extra-intestinal pathogenic Escherichia coli (ExPEC): Disease, carriage and clones

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