Abstract
PurposeMicrobial dysbiosis has been found preceding necrotizing enterocolitis (NEC) in preterm infants; thus, we aimed to investigate whether there is evidence that neonates with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) positive stool cultures are at higher risk for NEC at the NICU.MethodsWe included very preterm inborn infants of ≤ 32 weeks of gestational age being fecal carriers of ESBL-E and compared them with 1:1 matched (gestational age, birth weight, gender and year) controls tested negative for ESBL-E in the stool between 2005 and 2016. An association with NEC was defined as the first detection of ESBL-E before or at the time of definite diagnosis of NEC.ResultsDuring the study period, we diagnosed 217 infants with a total of 270 ESBL-E. We identified ten different species with ESBL-producing Klebsiella oxytoca being the most common one (46%) followed by Klebsiella pneumoniae (19%), and Citrobacter freundii (17%). Ten out of 217 infants had any kind of NEC in the case group compared to two of the controls (p < 0.01), but only four cases with predefined criteria were associated with NEC ≥ stage IIa (1.8 vs. 0.5%, p = 0.089, OR 4.1, CI95% 0.45–36.6). NEC mortality rate was 2/8 (25%).ConclusionsWe observed a threefold increase of ESBL-E in stool surveillance cultures during study time and germs were dominated by ESBL-producing Klebsiella spp. There was no evidence that preterm infants colonized with ESBL-E in the stool were at higher risk for definite NEC.
Highlights
Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales (ESBL-E) are a growing issue worldwide in health care systems and especially in intensive care units1 3 Vol.:(0123456789)[1]
Intestinal colonization with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) is regarded as a kind of dysbiosis of the neonatal microbiome and might be associated with the development of necrotizing enterocolitis (NEC) [2, 3]
Our hypothesis was that an altered gut microbiome due to ESBL-E dominated by Klebsiella spp. might increase the risk of developing NEC by the above describes pathomechanisms
Summary
Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales (ESBL-E) are a growing issue worldwide in health care systems and especially in intensive care units1 3 Vol.:(0123456789)[1]. Intestinal colonization with ESBL-E is regarded as a kind of dysbiosis of the neonatal microbiome and might be associated with the development of necrotizing enterocolitis (NEC) [2, 3]. Necrotizing enterocolitis (NEC) is—despite significant advances in neonatal intensive care of preterm infants—a complex and potentially devastating disease with high morbidity and mortality. It has been recently suggested that NEC is associated with a marked inhibition in both enterocyte migration and proliferation [6] This leads especially in preterm infants to further injury and to bacterial translocation. During these processes, bacteria are able to attack the innate immune defensive system and invade the intestinal epithelial layer with subsequent inflammation and tissue necrosis. Our hypothesis was that an altered gut microbiome due to ESBL-E dominated by Klebsiella spp. might increase the risk of developing NEC by the above describes pathomechanisms
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