Document Detail

Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates.
MedLine Citation:
PMID:  12700616     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: Patients receiving parenteral nutrition are at risk of septicaemia. Intestinal dysmotility and impaired gut immunity due to parenteral nutrition promote bacterial overgrowth. Gut overgrowth with aerobic Gram-negative bacilli (AGNB) impairs systemic immunity. The aim of this study was to determine the potential role of gut overgrowth with AGNB in the pathogenesis of septicaemia related to parenteral nutrition. METHODS: A prospective 5 y study of surgical infants less than 6 months of age was undertaken. Surveillance samples of the oropharynx and gut were obtained at the start of parenteral nutrition and thereafter twice weekly, to detect AGNB carriage. Blood cultures were taken on clinical indication only. RESULTS: Two-hundred and eight infants received parenteral nutrition for 6271 days (median 13 days, range 1-512 days). The incidence of AGNB carriage was 42%, whilst the septicaemia rate was 15%. Eighty-four percent of septicaemic infants carried AGNB, whilst 16% never carried AGNB (P<0.005). Carriage developed significantly earlier than septicaemia. CONCLUSIONS: The incidence of septicaemia was significantly greater in the subset of abnormal carriers. Although gut overgrowth with abnormal flora reflects illness severity, the fact that it preceded septicaemia implicates AGNB overgrowth, per se, as a contributory factor in the development of septicaemia related to parenteral nutrition. Prevention is unlikely to be successful if it ignores the abnormal flora.
H K F van Saene; N Taylor; S C Donnell; J Glynn; V L Magnall; Y Okada; N J Klein; A Pierro; D A Lloyd
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of clinical nutrition     Volume:  57     ISSN:  0954-3007     ISO Abbreviation:  Eur J Clin Nutr     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-17     Completed Date:  2003-07-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804070     Medline TA:  Eur J Clin Nutr     Country:  England    
Other Details:
Languages:  eng     Pagination:  548-53     Citation Subset:  IM    
Department of Clinical Microbiology/Infection Control, Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool, UK.
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MeSH Terms
Bacteremia / epidemiology,  microbiology
Birth Weight
Cohort Studies
Gestational Age
Gram-Negative Aerobic Bacteria
Gram-Negative Bacterial Infections / epidemiology,  etiology*,  microbiology
Infant, Newborn
Intestinal Diseases / microbiology,  surgery*,  therapy
Parenteral Nutrition / adverse effects*
Prospective Studies
Time Factors

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