Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study

• Published in: The Journal of hospital infection Vol. 52; no. 4; pp. 273 - 280
• Main Authors: Donnell, S.C., Taylor, N., van Saene, H.K.F., Magnall, V.L., Pierro, A., Lloyd, D.A.
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01.12.2002; Elsevier
• Subjects: Bacteremia - epidemiology; Bacteremia - etiology; Bacteremia - prevention & control; Bacterial diseases; Bacterial sepsis; Bacterial Translocation; Biological and medical sciences; Catheters, Indwelling - adverse effects; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; England - epidemiology; Female; Fungemia - epidemiology; Fungemia - etiology; Fungemia - prevention & control; Hospitals, Pediatric; Human bacterial diseases; Humans; Incidence; Infant; Infant, Newborn; Infection Control - methods; Infectious diseases; Liver Function Tests; Male; Medical sciences; Microbial Sensitivity Tests; Parenteral Nutrition - adverse effects; Parenteral nutrition, infection, translocation, surgery neonates, infants; Pharynx - microbiology; Prospective Studies; Rectum - microbiology; Risk Factors; England; Parenteral nutrition, infection, translocation, surgery neonates, infants; Human; Postoperative; Nosocomial infection; infection; infants; translocation; Microbiology; Septicemia; Rate; Infant; Parenteral nutrition; Parenteral administration; Feeding; Microbiological investigation; Newborn; Etiology; Risk factor; surgery neonates
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1053/jhin.2002.1318

We performed a prospective, observational, cohort study on 208 surgical neonates and infants between 1992 and 1997. Surveillance cultures of the oropharynx and rectum were obtained at the start of parenteral nutrition and thereafter twice weekly. Blood cultures were taken on clinical indication only. Microbial translocation was diagnosed when the micro-organisms in the blood were not distinguishable from those carried in the oropharynx and/or rectum. Liver function was monitored weekly and when septicaemia was suspected. The incidence of septicaemia was 15%. The predominant micro-organisms (86%) were the low-level pathogens, coagulase-negative staphylococci and enterococci. Potential pathogens, including aerobic Gram-negative bacilli, were responsible for the remainder. Microbial translocation was responsible for 84% of septicaemic episodes in 76% of patients. The potential pathogens caused septicaemia significantly later than coagulase-negative staphylococci, at a time when liver function was significantly more impaired. In neonates and infants receiving parenteral nutrition, septicaemia is mainly a gut-derived phenomenon and requires novel strategies for prevention.