Septicaemia Due to Enteric Organisms is a Later Event in Surgical Infants Requiring Parenteral Nutrition

Abstract

Introduction The purpose of this study was to determine whether, in surgical infants requiring parenteral nutrition (PN), septicaemia due to enterococci or Gram-negative bacilli occurs later than septicaemia due to coagulase-negative staphylococci (CNS).

Patients/Material and Methods We retrospectively studied 112 consecutive surgical infants (corrected gestational age up to 3 months) receiving PN for at least 5 days for congenital or acquired intestinal anomalies over a 2-year period (July 2007–June 2009). Data collected included diagnosis, duration of PN, episodes of septicaemia (defined as growth of bacteria from blood culture), and organisms cultured. We compared the time to first occurrence of septicaemia due to CNS with the times to first occurrence of septicaemia due to enterococci, Gram-negative bacilli, or other micro-organisms, using Kruskal-Wallis nonparametric ANOVA test and Dunn’s multiple comparisons test. Data are given as median (range).

Results 31 patients (28%) had a total of 65 episodes of septicaemia. Septicaemia due to CNS was most common, occurring in 22% of patients, after 17 days (1–239) of PN. Septicaemia due to enteric organisms was less common and occurred significantly later, at 59 (24–103) days for enterococci (p<0.01), and at 55 (30–106) days for Gram-negative bacilli (p<0.05).

Conclusions Septicaemia due to enterococci or Gram-negative bacilli occurs later in the course of PN than septicaemia due to CNS, in surgical infants. This suggests that these infants become more vulnerable to the translocation of enteric micro-organisms after a longer period of parenteral nutrition.

Keywords

infection - bacterial translocation - neonatal intestinal obstruction - necrotising enterocolitis - gastroschisis

• References

• 1 Pierro A, van Saene HK, Jones MO , et al. Clinical impact of abnormal gut flora in infants receiving parenteral nutrition. Ann Surg 1998; 227: 547-552
• 2 Pierro A, van Saene HK, Donnell SC , et al. Microbial translocation in neonates and infants receiving long-term parenteral nutrition. Arch Surg 1996; 131: 176-179
• 3 Donnell SC, Taylor N, van Saene HK , et al. Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study. J Hosp Infect 2002; 52: 273-280
• 4 Holden CE, Sexton E, Gray J. Septicaemia in infants receiving parenteral nutrition. J Hosp Infect 2003; 54: 165-167
• 5 Donnell SC, Taylor N, van Saene HK. Translocation cannot be ignored during parenteral nutrition. J Hosp Infect 2004; 56: 246-247
• 6 Van Camp JM, Tomaselli V, Coran AG. Bacterial translocation in the neonate. Curr Opin Pediatr 1994; 6: 327-333
• 7 Page S, Abel G, Stringer MD , et al. Management of septicaemic infants during long-term parenteral nutrition. Int J Clin Pract 2000; 54: 147-150
• 8 Okada Y, Klein NJ, van Saene HK , et al. Bactericidal activity against coagulase-negative staphylococci is impaired in infants receiving long-term parenteral nutrition. Ann Surg 2000; 231: 276-281
• 9 Okada Y, Klein NJ, Pierro A. Neutrophil dysfunction the cellular mechanism of impaired immunity during total parenteral nutrition in infancy. J Pediatr Surg 1999; 34: 242-245
• 10 Okada Y, Papp E, Klein NJ , et al. Total parenteral nutrition directly impairs cytokine production after bacterial challenge. J Pediatr Surg 1999; 34: 277-280
• 11 Bishay M, Retrosi G, Horn V , et al. Chlorhexidine antisepsis significantly reduces the incidence of sepsis and septicemia during parenteral nutrition in surgical infants. J Pediatr Surg 2011; 46: 1064-1069
• 12 Liberati A, D’Amico R, Pifferi S , et al. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 2009; CD000022
• 13 de Smet AM, Kluytmans JA, Blok HE , et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis 2011; 11: 372-380
• 14 Roos D, Dijksman LM, Oudemans-van Straaten HM , et al. Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery. Br J Surg 2011; 98: 1365-1372
• 15 Donnell SC, Taylor N, van Saene HK , et al. Nutritional implications of gut overgrowth and selective decontamination of the digestive tract. Proc Nutr Soc 1998; 57: 381-387
• 16 Deshpande G, Rao S, Patole S , et al. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics 2010; 125: 921-930