Sepsis From the Gut: The Enteric Habitat of Bacteria That Cause Late-Onset Neonatal Bloodstream Infections
Sepsis From the Gut: The Enteric Habitat of Bacteria That Cause Late-Onset Neonatal Bloodstream Infections
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DOI：
10.1093/cid/ciu084
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发表时间：
2014-05-01
影响因子：
11.8
通讯作者：
Tarr, Phillip I.
中科院分区：
文献类型：
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作者：
Carl, Mike A.;Ndao, I. Malick;Tarr, Phillip I.
背景迟发性脓毒症是泌尿外科的一个主要问题，但在血流侵袭发生之前病原体的栖息地还没有很好的确定。我们前瞻性地检查了从患有败血症的早产儿收集的粪便，以发现随后侵入其血液的病原体，并在没有败血症的婴儿的粪便中寻找相同的微生物。基于培养的技术用于分离暂时匹配血流微生物的粪便细菌，然后对其进行基因组测序以确认或反驳共性。在11例迟发性新生儿血流感染患儿中，7例在败血症发作前产生至少1次粪便，粪便中含有B族链球菌（GBS）、粘质沙雷氏菌或大肠埃希氏菌，并暂时匹配微生物。在96例重叠比较受试者中，没有与这些病例暂时相关的脓毒症，4例被暂时匹配的GBS或S定植。marcescens。在随机选择的无败血症婴儿的175份粪便比较中，1份含有GBS（该婴儿也作为重叠比较受试者，两份标本均含有临时匹配的GBS）。基因组测序证实了暂时匹配的粪便和血液分离株的共同来源。入侵E.大肠杆菌存在于出生后的所有败血症前粪便中，但肠道定植有GBS和S。粘质沙雷氏菌发生时间与血流感染时间较接近。新生儿肠道含有引起败血症的病原体，但这些生物体并不是正常微生物群的必然成员。监测微生物学、去殖民化和加强卫生可能会防止早产儿之间和早产儿内部的侵入性细菌传播。
Background. Late-onset sepsis is a major problem in neonatology, but the habitat of the pathogens before bloodstream invasion occurs is not well established.Methods. We examined prospectively collected stools from premature infants with sepsis to find pathogens that subsequently invaded their bloodstreams, and sought the same organisms in stools of infants without sepsis. Culture-based techniques were used to isolate stool bacteria that provisionally matched the bloodstream organisms, which were then genome sequenced to confirm or refute commonality.Results. Of 11 children with late-onset neonatal bloodstream infections, 7 produced at least 1 stool that contained group B Streptococcus (GBS), Serratia marcescens, or Escherichia coli before their sepsis episode with provisionally matching organisms. Of 96 overlap comparison subjects without sepsis temporally associated with these cases, 4 were colonized with provisionally matching GBS or S. marcescens. Of 175 comparisons of stools from randomly selected infants without sepsis, 1 contained a GBS (this infant had also served as an overlap comparison subject and both specimens contained provisionally matching GBS). Genome sequencing confirmed common origin of provisionally matching fecal and blood isolates. The invasive E. coli were present in all presepticemic stools since birth, but gut colonization with GBS and S. marcescens occurred closer to time of bloodstream infection.Conclusions. The neonatal gut harbors sepsis-causing pathogens, but such organisms are not inevitable members of the normal microbiota. Surveillance microbiology, decolonization, and augmented hygiene might prevent dissemination of invasive bacteria between and within premature infants.