Nosocomial Sepsis in Neonatal Intensive Care: Inevitable or Preventable?

Abstract

Very low birth weight (VLBW) infants are at high risk to develop a neonatal nosocomial sepsis. The incidence of neonatal nosocomial, late-onset sepsis (LOS) is about 20–30%, but a rate of up to 43% has been reported among neonates with a birth weight of 400–750 g. Preventive and treatment strategies for neonatal sepsis in VLBW infants are aiming to enhance the infant’s host defence mechanisms. Neonatal immunodeficiencies include quantitative and qualitative deficits in phagocytes, complement components, and immunoglobulins. A considerable number of immune strategies has been investigated in carefully designed multicentre trials. These include exchange transfusion, neutrophil transfusion, hematopoietic growth factors such as granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF), intravenous immunoglobulins (IVIG), and others. Since none of these interventions was able to reduce the mortality rate of immature preterm infants, the current evidence does not support the use of any of the immune strategies for prevention or treatment of neonatal sepsis. Decreasing the burden of intensive care and following strict hygiene programs at NICUs may be the most promising current strategies to minimise nosocomial infection.

Zusammenfassung

Sehr unreife Frühgeborene haben ein hohes Risiko an einer nosokomialen Sepsis zu erkran­ken. Bis zu 30% der Frühgeborenen mit einem Geburtsgewicht <1 500 g und mehr als 40% mit einem Geburtsgewicht von 400–750 g entwickeln im Verlauf der intensivmedizinischen Behandlung eine Sepsis, die zu einer erhöhten Letalität und Morbidität dieser Hochrisikopatienten beiträgt. Verschiedene präventive und therapeutische Strategien wurden in überwie­gend kontrollierten, randomisierten Studien mit dem Ziel untersucht, eine Reihe von partiellen Immundefizienzen unreifer Frühgeborener wie die quantitativen und qualitativen Funktionseinschränkungen im Phagozyten- und humoralen Immunsystem zu korrigieren. Zu diesen Strategien gehören die Austauschtransfusion, Granulozy­tentransfusion, die Gabe von hämatopoetischen Wachstumsfaktoren (GM-CSF, G-CSF), die intravenöse Immunglobulinsubstitution u. a. Da keine dieser Interventionen die Sterblichkeit von unreifen Frühgeborenen reduzieren konnte, sollte bei fehlender Evidenz von einem klinischen Einsatz dieser Strategien zur Prävention und Behandlung der nosokomialen Sepsis Frühgeborener abgesehen werden. Eine reduzierte Dauer und Intensität der intensivmedizinischen Maßnahmen sowie strikte Hygienevorschriften sind vermutlich die Strate­gien, die am ehesten zu einer Abnahme der Sepsisinzidenz beitragen können.

Key words

granulocyte colony-­stimulating factor - granulocyte-macrophage colony-stimulating factor - intravenous ­immunoglobulins - hygienic strategies - neonates - nosocomial sepsis

Schlüsselwörter

Frühgeborene - nasokomiale Sepsis - hämatopoetische ­Wachstumsfaktoren - intravenöse Immunglobulinsubstitution

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