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Factors influencing oral colonization in premature infants
Imad R Makhoul1, Polo Sujov, Leon Ardekian
1Department of Neonatology, Rambam Medical Center, Haifa, Israel. Makhoul@rambam.health.gov.il
Insights
Oral bacterial colonization increases in premature infants from day 1 to day 10. Antibacterial therapy alters oral flora by day 10, impacting treatment decisions for late-onset sepsis.
Area of Science:
- Neonatal Medicine
- Microbiology
- Pediatric Infectious Diseases
Background:
- Oral flora in premature infants is under-investigated.
- Understanding factors influencing oral microbiota is crucial for infant health.
Purpose of the Study:
- To examine how gestational age and antibacterial therapy (ABT) affect the oral flora of premature infants.
- To analyze changes in oral colonization from day 1 to day 10 of life.
Main Methods:
- Oral cultures were collected from 65 premature infants at 1 and 10 days old.
- Infants were grouped by gestational age (30-34 weeks vs. <30 weeks) and ABT use.
- Comparison of oral flora composition based on gestational age and ABT exposure.
Main Results:
- Oral bacterial colonization increased significantly between day 1 and day 10.
- Gestational age did not impact early or late oral colonization or bacteremia.
- Antibacterial therapy significantly altered the day 10 oral flora, with coagulase-negative staphylococci and non-E. coli gram-negative bacteria dominating in treated infants.
Conclusions:
- Oral bacterial acquisition progresses from day 1 to day 10, irrespective of gestational age or ABT.
- Antibacterial therapy demonstrably shifts the oral bacterial spectrum in premature infants by day 10.
- Findings are important for guiding empirical antimicrobial strategies in premature infants with suspected late-onset sepsis.
Background:
Factors influencing the oral flora of premature infants have not been adequately investigated.
Objective:
To investigate the effects of gestational age and of anti-bacterial therapy on the oral flora of premature infants.
Methods:
Oral cultures were obtained at age 1 day and age 10 days from 65 premature infants, divided into three groups: a) 24 neonates of 30-34 weeks gestation who did not receive ABT, b) 23 neonates of 30-34 weeks gestation who received ABT, and c) 18 neonates < 30 weeks gestation who received ABT.
Results:
Oral bacterial colonization increased from day 1 to day 10 of life. In 24-34 week neonates, gestational age did not affect early bacteremia or oral colonization at birth. Neither gestational age nor ABT affected late bacteremia or oral colonization at day 10. In 30-34 week neonates with ABT, the oral flora consisted mainly of non-Escherichia coli gram-negative bacteria, whereas those who did not receive ABT grew mainly alpha-hemolytic streptococci, Klebsiella pneumoniae and E. coli. In neonates < 30 weeks who received ABT the oral flora were mainly coagulase-negative staphylococci. Oral colonization with anaerobes was zero and colonization with fungi was minimal.
Conclusions:
Acquisition of oral bacteria rose from day 1 to day 10 of life, regardless of gestational life or ABT. On day 10 of life, the spectrum of oral bacterial flora changed following ABT and consisted mainly of coagulase-negative Staphylococcus and non-E. coli gram-negative bacteria. Oral colonization showed few fungi but no anaerobes. These microbiologic observations merit attention when empirical anti-microbial therapy is considered in premature infants suspected of having late-onset sepsis.