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

Abstract

The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

Early-Onset Neonatal Sepsis

“…coli is the second leading cause of EOS in neonates, accounting for about 24% of all EOS episodes, with 81% of cases occurring in preterm infants (57). When VLBW infants are considered alone, E. coli is the most frequent cause of EOS, accounting for 33.4% of episodes in a large, multicenter study (3).…”

“…Term infants are at higher risk of infection if they have comorbidities such as impaired immune function, meconium aspiration, galactosemia, and underlying cardiac or pulmonary abnormalities (57).…”

“…(Adapted from reference 102. ) ter IPA adoption, the primary cause of disease in the preterm infant population has changed, from a predominance of GBS in the early 1990s to a majority of Gram-negative organisms in the most recent reports from 2012 (34,57). Concern has been raised about reports of increasing ampicillin resistance in E. coli strains from this high-risk population in recent years (267,302).…”

Vertebral Complications of Late-Onset Neonatal Sepsis

“…При этом выделение микробиоты не имеет решающего значения для постанов-ки диагноза, ведение которого, тем не менее, осуществляется по принци-пам интенсивной синдромной тера-пии [22,23].…”

Retrospective Epidemiological Investigation on Nosocomial Neonatal Sepsis in Shaanxi Province (2008-2010)

“…Zero" philosophy requires strategies to prevent NNS, including improved hand hygiene, early breast milk feeding, limited use of invasive devices, rational use of antibiotics, and improved teamwork to contain infection [30].…”