Skip to main content
Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases 7/2010

01.07.2010 | Article

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

verfasst von: Ü. Parm, T. Metsvaht, E. Sepp, M.-L. Ilmoja, H. Pisarev, M. Pauskar, I. Lutsar

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 7/2010

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this study was to compare the impact of ampicillin and penicillin used for empiric treatment of early onset sepsis (EOS) on initial gut colonization by aerobic and facultative anaerobic microorganisms. A cluster-randomized, two-center, switch-over study was conducted in two paediatric intensive care units in Estonia and included 276 neonates. Rectal swabs were collected twice a week until discharge or day 60. Colonizing microbes were identified on species level and tested for ampicillin resistance (AR). The number of patients colonized with Gram negative microorganisms and Candida spp was similar in both treatment arms but ampicillin resulted in longer colonization duration (CD) of K. pneumonia (p = 0.012), AR Serratia spp (p = 0.012) and Candida spp (p = 0.02) and penicillin in that of AR Acinetobacter spp (p = 0.001). As for Gram positive microorganisms penicillin treatment was associated with a greater number of colonized patients and higher CD of Enterococcus spp and S. aureus but lower ones of S. haemolyticus and S. hominis. Influence of ampicillin and penicillin on initial gut colonization is somewhat different but these differences are of low clinical relevance and should not be a limiting step when choosing between these two antibiotics for the empiric treatment of EOS.
Literatur
1.
Zurück zum Zitat Donskey CJ (2004) The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39:219–226CrossRefPubMed Donskey CJ (2004) The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39:219–226CrossRefPubMed
2.
Zurück zum Zitat Sullivan A, Edlund C, Nord CE (2001) Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis 1:101–114CrossRefPubMed Sullivan A, Edlund C, Nord CE (2001) Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis 1:101–114CrossRefPubMed
3.
Zurück zum Zitat Young TE, Mangum B (2004) Neofax: a manual of drugs used in neonatal care. Acorn Publishing, Raleigh Young TE, Mangum B (2004) Neofax: a manual of drugs used in neonatal care. Acorn Publishing, Raleigh
4.
Zurück zum Zitat Mehta D (2005) BNF49: British National Formulary. Pharmaceutical Press, Wallingford Mehta D (2005) BNF49: British National Formulary. Pharmaceutical Press, Wallingford
5.
Zurück zum Zitat Bonnemaison E, Lanotte P, Cantagrel S, Thionois S, Quentin R, Chamboux C, Laugier J (2003) Comparison of fecal flora following administration of two antibiotic protocols for suspected maternofetal infection. Biol Neonate 84:304–310CrossRefPubMed Bonnemaison E, Lanotte P, Cantagrel S, Thionois S, Quentin R, Chamboux C, Laugier J (2003) Comparison of fecal flora following administration of two antibiotic protocols for suspected maternofetal infection. Biol Neonate 84:304–310CrossRefPubMed
6.
Zurück zum Zitat Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, Laptook A, Walsh M, Oh W, Hale E (2005) Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002–2003. Pediatr Infect Dis J 24:635–639CrossRefPubMed Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, Laptook A, Walsh M, Oh W, Hale E (2005) Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002–2003. Pediatr Infect Dis J 24:635–639CrossRefPubMed
7.
Zurück zum Zitat Gewolb IH, Schwalbe RS, Taciak VL, Harrison TS, Panigrahi P (1999) Stool microflora in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 80:F167–F173CrossRefPubMed Gewolb IH, Schwalbe RS, Taciak VL, Harrison TS, Panigrahi P (1999) Stool microflora in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 80:F167–F173CrossRefPubMed
8.
Zurück zum Zitat Bennet R, Eriksson M, Nord CE, Zetterstrom R (1982) Suppression of aerobic and anaerobic faecal flora in newborns receiving parenteral gentamicin and ampicillin. Acta Paediatr Scand 71:559–562CrossRefPubMed Bennet R, Eriksson M, Nord CE, Zetterstrom R (1982) Suppression of aerobic and anaerobic faecal flora in newborns receiving parenteral gentamicin and ampicillin. Acta Paediatr Scand 71:559–562CrossRefPubMed
9.
Zurück zum Zitat de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN (2000) An antibiotic policy to prevent emergence of resistant bacilli. Lancet 355:973–978CrossRefPubMed de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN (2000) An antibiotic policy to prevent emergence of resistant bacilli. Lancet 355:973–978CrossRefPubMed
10.
Zurück zum Zitat Laugel V, Kuhn P, Beladdale J, Donato L, Escande B, Astruc D, Messer J (2003) Effects of antenatal antibiotics on the incidence and bacteriological profile of early-onset neonatal sepsis. A retrospective study over five years. Biol Neonate 84:24–30CrossRefPubMed Laugel V, Kuhn P, Beladdale J, Donato L, Escande B, Astruc D, Messer J (2003) Effects of antenatal antibiotics on the incidence and bacteriological profile of early-onset neonatal sepsis. A retrospective study over five years. Biol Neonate 84:24–30CrossRefPubMed
11.
Zurück zum Zitat Jaureguy F, Carton M, Panel P, Foucaud P, Butel MJ, Doucet-Populaire F (2004) Effects of intrapartum penicillin prophylaxis on intestinal bacterial colonization in infants. J Clin Microbiol 42:5184–5188CrossRefPubMed Jaureguy F, Carton M, Panel P, Foucaud P, Butel MJ, Doucet-Populaire F (2004) Effects of intrapartum penicillin prophylaxis on intestinal bacterial colonization in infants. J Clin Microbiol 42:5184–5188CrossRefPubMed
12.
Zurück zum Zitat Westerbeek EA, van den Berg A, Lafeber HN, Knol J, Fetter WP, van Elburg RM (2006) The intestinal bacterial colonisation in preterm infants: a review of the literature. Clin Nutr 25:361–368CrossRefPubMed Westerbeek EA, van den Berg A, Lafeber HN, Knol J, Fetter WP, van Elburg RM (2006) The intestinal bacterial colonisation in preterm infants: a review of the literature. Clin Nutr 25:361–368CrossRefPubMed
13.
Zurück zum Zitat Graham PL 3rd, Della-Latta P, Wu F, Zhou J, Saiman L (2007) The gastrointestinal tract serves as the reservoir for Gram-negative pathogens in very low birth weight infants. Pediatr Infect Dis J 26:1153–1156CrossRefPubMed Graham PL 3rd, Della-Latta P, Wu F, Zhou J, Saiman L (2007) The gastrointestinal tract serves as the reservoir for Gram-negative pathogens in very low birth weight infants. Pediatr Infect Dis J 26:1153–1156CrossRefPubMed
14.
Zurück zum Zitat Costa SF, Miceli MH, Anaissie EJ (2004) Mucosa or skin as source of coagulase-negative staphylococcal bacteraemia? Lancet Infect Dis 4:278–286CrossRefPubMed Costa SF, Miceli MH, Anaissie EJ (2004) Mucosa or skin as source of coagulase-negative staphylococcal bacteraemia? Lancet Infect Dis 4:278–286CrossRefPubMed
15.
Zurück zum Zitat Metsvaht T, Ilmoja ML, Parm U, Maipuu L, Merila M, Lutsar I (2010) Comparison of ampicillin plus gentamicin vs. penicillin plus gentamicin in empiric treatment of neonates at risk of early onset sepsis. Acta Paediatr 99:665–672 Metsvaht T, Ilmoja ML, Parm U, Maipuu L, Merila M, Lutsar I (2010) Comparison of ampicillin plus gentamicin vs. penicillin plus gentamicin in empiric treatment of neonates at risk of early onset sepsis. Acta Paediatr 99:665–672
16.
Zurück zum Zitat Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A (2002) Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 51:1–22PubMed Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A (2002) Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 51:1–22PubMed
17.
Zurück zum Zitat CLSI (2005) Performance standards for antimicrobial susceptibility testing; fifteenth informational supplement. Clinical and Laboratory Standards Institute, pp 24–25 CLSI (2005) Performance standards for antimicrobial susceptibility testing; fifteenth informational supplement. Clinical and Laboratory Standards Institute, pp 24–25
18.
Zurück zum Zitat Brakstad OG, Aasbakk K, Maeland JA (1992) Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene. J Clin Microbiol 30:1654–1660PubMed Brakstad OG, Aasbakk K, Maeland JA (1992) Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene. J Clin Microbiol 30:1654–1660PubMed
19.
Zurück zum Zitat Chambers HF (1997) Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clin Microbiol Rev 10:781–791PubMed Chambers HF (1997) Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clin Microbiol Rev 10:781–791PubMed
20.
Zurück zum Zitat Adlerberth I, Lindberg E, Aberg N, Hesselmar B, Saalman R, Strannegard IL, Wold AE (2006) Reduced enterobacterial and increased staphylococcal colonization of the infantile bowel: an effect of hygienic lifestyle? Pediatr Res 59:96–101CrossRefPubMed Adlerberth I, Lindberg E, Aberg N, Hesselmar B, Saalman R, Strannegard IL, Wold AE (2006) Reduced enterobacterial and increased staphylococcal colonization of the infantile bowel: an effect of hygienic lifestyle? Pediatr Res 59:96–101CrossRefPubMed
21.
Zurück zum Zitat Heikkila MP, Saris PE (2003) Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol 95:471–478CrossRefPubMed Heikkila MP, Saris PE (2003) Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol 95:471–478CrossRefPubMed
22.
Zurück zum Zitat Almuneef MA, Baltimore RS, Farrel PA, Reagan-Cirincione P, Dembry LM (2001) Molecular typing demonstrating transmission of gram-negative rods in a neonatal intensive care unit in the absence of a recognized epidemic. Clin Infect Dis 32:220–227CrossRefPubMed Almuneef MA, Baltimore RS, Farrel PA, Reagan-Cirincione P, Dembry LM (2001) Molecular typing demonstrating transmission of gram-negative rods in a neonatal intensive care unit in the absence of a recognized epidemic. Clin Infect Dis 32:220–227CrossRefPubMed
23.
Zurück zum Zitat Ronnestad A, Abrahamsen TG, Medbo S, Reigstad H, Lossius K, Kaaresen PI, Engelund IE, Irgens LM, Markestad T (2005) Septicemia in the first week of life in a Norwegian national cohort of extremely premature infants. Pediatrics 115:e262–e268CrossRefPubMed Ronnestad A, Abrahamsen TG, Medbo S, Reigstad H, Lossius K, Kaaresen PI, Engelund IE, Irgens LM, Markestad T (2005) Septicemia in the first week of life in a Norwegian national cohort of extremely premature infants. Pediatrics 115:e262–e268CrossRefPubMed
24.
Zurück zum Zitat Schwiertz A, Gruhl B, Lobnitz M, Michel P, Radke M, Blaut M (2003) Development of the intestinal bacterial composition in hospitalized preterm infants in comparison with breast-fed, full-term infants. Pediatr Res 54:393–399CrossRefPubMed Schwiertz A, Gruhl B, Lobnitz M, Michel P, Radke M, Blaut M (2003) Development of the intestinal bacterial composition in hospitalized preterm infants in comparison with breast-fed, full-term infants. Pediatr Res 54:393–399CrossRefPubMed
25.
Zurück zum Zitat Mammina C, Di Carlo P, Cipolla D, Giuffre M, Casuccio A, Di Gaetano V, Plano MR, D’Angelo E, Titone L, Corsello G (2007) Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission. Am J Infect Control 35:222–230CrossRefPubMed Mammina C, Di Carlo P, Cipolla D, Giuffre M, Casuccio A, Di Gaetano V, Plano MR, D’Angelo E, Titone L, Corsello G (2007) Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission. Am J Infect Control 35:222–230CrossRefPubMed
26.
Zurück zum Zitat Srivastava S, Shetty N (2007) Healthcare-associated infections in neonatal units: lessons from contrasting worlds. J Hosp Infect 65:292–306CrossRefPubMed Srivastava S, Shetty N (2007) Healthcare-associated infections in neonatal units: lessons from contrasting worlds. J Hosp Infect 65:292–306CrossRefPubMed
27.
Zurück zum Zitat Tapiainen T, Ylitalo S, Eerola E, Uhari M (2006) Dynamics of gut colonization and source of intestinal flora in healthy newborn infants. APMIS 114:812–817CrossRefPubMed Tapiainen T, Ylitalo S, Eerola E, Uhari M (2006) Dynamics of gut colonization and source of intestinal flora in healthy newborn infants. APMIS 114:812–817CrossRefPubMed
28.
Zurück zum Zitat Mackie RI, Sghir A, Gaskins HR (1999) Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr 69:1035S–1045SPubMed Mackie RI, Sghir A, Gaskins HR (1999) Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr 69:1035S–1045SPubMed
29.
Zurück zum Zitat Edwards RK, Clark P, Sistrom CL, Duff P (2002) Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens. Obstet Gynecol 100:534–539CrossRefPubMed Edwards RK, Clark P, Sistrom CL, Duff P (2002) Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens. Obstet Gynecol 100:534–539CrossRefPubMed
30.
Zurück zum Zitat Duman M, Abacioglu H, Karaman M, Duman N, Ozkan H (2005) Beta-lactam antibiotic resistance in aerobic commensal fecal flora of newborns. Pediatr Int 47:267–273CrossRefPubMed Duman M, Abacioglu H, Karaman M, Duman N, Ozkan H (2005) Beta-lactam antibiotic resistance in aerobic commensal fecal flora of newborns. Pediatr Int 47:267–273CrossRefPubMed
31.
Zurück zum Zitat Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG (2008) Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 121:689–696CrossRefPubMed Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG (2008) Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 121:689–696CrossRefPubMed
32.
Zurück zum Zitat Mitt P, Adamson V, Loivukene K, Lang K, Telling K, Paro K, Room A, Naaber P, Maimets M (2009) Epidemiology of nosocomial bloodstream infections in Estonia. J Hosp Infect 71:365–370CrossRefPubMed Mitt P, Adamson V, Loivukene K, Lang K, Telling K, Paro K, Room A, Naaber P, Maimets M (2009) Epidemiology of nosocomial bloodstream infections in Estonia. J Hosp Infect 71:365–370CrossRefPubMed
33.
Zurück zum Zitat Bennet R, Eriksson M, Nord CE (2002) The fecal microflora of 1-3-month-old infants during treatment with eight oral antibiotics. Infection 30:158–160CrossRefPubMed Bennet R, Eriksson M, Nord CE (2002) The fecal microflora of 1-3-month-old infants during treatment with eight oral antibiotics. Infection 30:158–160CrossRefPubMed
34.
Zurück zum Zitat Loivukene K, Kermes K, Sepp E, Adamson V, Mitt P, Jurna M, Magi H, Kallandi U, Otter K, Naaber P (2006) The comparison of susceptibility patterns of Gram-negative invasive and non-invasive pathogens in Estonian hospitals. Antonie Leeuwenhoek 89:367–371CrossRefPubMed Loivukene K, Kermes K, Sepp E, Adamson V, Mitt P, Jurna M, Magi H, Kallandi U, Otter K, Naaber P (2006) The comparison of susceptibility patterns of Gram-negative invasive and non-invasive pathogens in Estonian hospitals. Antonie Leeuwenhoek 89:367–371CrossRefPubMed
35.
Zurück zum Zitat Cassettari VC, da Silveira IR, Dropa M, Lincopan N, Mamizuka EM, Matte MH, Matte GR, Menezes PR (2009) Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. J Hosp Infect 71:340–347CrossRefPubMed Cassettari VC, da Silveira IR, Dropa M, Lincopan N, Mamizuka EM, Matte MH, Matte GR, Menezes PR (2009) Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. J Hosp Infect 71:340–347CrossRefPubMed
36.
Zurück zum Zitat Fraser S (2006) Enterococcal infections: eMedicine Specialties. EMedicine, pp 1–18 Fraser S (2006) Enterococcal infections: eMedicine Specialties. EMedicine, pp 1–18
37.
Zurück zum Zitat Miedema CJ, Kerkhof M, Arends JP, Bergman KA, Kimpen JL (2000) Risk factors for colonization with enterococci in a neonatal intensive care unit. Clin Microbiol Infect 6:53CrossRefPubMed Miedema CJ, Kerkhof M, Arends JP, Bergman KA, Kimpen JL (2000) Risk factors for colonization with enterococci in a neonatal intensive care unit. Clin Microbiol Infect 6:53CrossRefPubMed
38.
Zurück zum Zitat Hufnagel M, Liese C, Loescher C, Kunze M, Proempeler H, Berner R, Krueger M (2007) Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns. BMC Infect Dis 7:107CrossRefPubMed Hufnagel M, Liese C, Loescher C, Kunze M, Proempeler H, Berner R, Krueger M (2007) Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns. BMC Infect Dis 7:107CrossRefPubMed
39.
Zurück zum Zitat Drozenova J, Petras P (2000) Characteristics of coagulase-negative staphylococci isolated from hemocultures. Epidemiol Mikrobiol Imunol 49:51–58PubMed Drozenova J, Petras P (2000) Characteristics of coagulase-negative staphylococci isolated from hemocultures. Epidemiol Mikrobiol Imunol 49:51–58PubMed
40.
Zurück zum Zitat Koksal F, Yasar H, Samasti M (2009) Antibiotic resistance patterns of coagulase-negative staphylococcus strains isolated from blood cultures of septicemic patients in Turkey. Microbiol Res 164:404–410CrossRefPubMed Koksal F, Yasar H, Samasti M (2009) Antibiotic resistance patterns of coagulase-negative staphylococcus strains isolated from blood cultures of septicemic patients in Turkey. Microbiol Res 164:404–410CrossRefPubMed
41.
Zurück zum Zitat Arslan S, Ozkardes F (2007) Slime production and antibiotic susceptibility in staphylococci isolated from clinical samples. Mem Inst Oswaldo Cruz 102:29–33CrossRefPubMed Arslan S, Ozkardes F (2007) Slime production and antibiotic susceptibility in staphylococci isolated from clinical samples. Mem Inst Oswaldo Cruz 102:29–33CrossRefPubMed
Metadaten
Titel
Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis
verfasst von
Ü. Parm
T. Metsvaht
E. Sepp
M.-L. Ilmoja
H. Pisarev
M. Pauskar
I. Lutsar
Publikationsdatum
01.07.2010
Verlag
Springer-Verlag
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 7/2010
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-010-0931-1

Weitere Artikel der Ausgabe 7/2010

European Journal of Clinical Microbiology & Infectious Diseases 7/2010 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren. 

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.