Pathogenesis of colonization and infection in a neonatal surgical unit

Nosocomial infection with aerobic Gram-negative bacilli is a major cause of morbidity and mortality in neonates. Few prospective studies have been undertaken in neonatal surgical units to investigate colonization and infection rates and the pathogenesis of infection. We prospectively studied 40 infants admitted to a neonatal surgical unit. Ninety-eight percent became colonized in throat/intestine with aerobic Gram-negative bacilli. Thirty-five percent developed infections, with wound and surface infections predominant (61%). Ninety-one percent of infections were caused by Gram-negative bacilli or yeasts. Severe infections (septicemia, pneumonia, meningitis) occurred in 13% of infants. The mortality rate was 5%. In all infections, the pathogenesis was found to be endogenous, and in most, three stages were distinguishable. Neonates always acquired potentially pathogenic organisms in throat/intestine (stage 1) before colonization (stage 2) and infection (stage 3) of other systems occurred. Reduction of digestive tract colonization by these potentially pathogenic microorganisms by means of successful selective decontamination may therefore reduce subsequent infection.