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Anaerobic bacteremia in a neonatal intensive care unit: an eighteen-year experience
G J Noel1, D A Laufer, P J Edelson
1Department of Pediatrics, New York Hospital-Cornell University Medical Center, NY 10021.
Abstract:
A review of anaerobic bacteremia in the Neonatal Intensive Care Unit identified 29 episodes of clinically significant bacteremia occurring over the past 18 years. This experience suggested that certain clinical settings were associated with specific anaerobic infections. Although Gram-positive and Gram-negative anaerobes were isolated with similar frequency, 8 of 12 infants bacteremic within the first 48 hours of life were infected with Gram-positive, penicillin G-susceptible organisms whereas 11 of 17 infants older than 2 days were bacteremic with Gram-negative, penicillin G-resistant anaerobes. Eleven of 17 infants with anaerobic bacteremia associated with necrotizing enterocolitis were bacteremic with Gram-negative anaerobes. Five of 6 infants with anaerobic bacteremia associated with chorioamnionitis were bacteremic with Gram-positive anaerobes. These observations should be considered in making decisions regarding empiric therapy for the newborn at highest risk for anaerobic bacteremia.
Insights
Neonatal anaerobic bacteremia patterns differ by age and infection source. Early-onset infections often involve Gram-positive organisms, while later infections and necrotizing enterocolitis are linked to Gram-negative anaerobes.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Anaerobic bacteremia is a serious concern in Neonatal Intensive Care Units (NICUs).
- Understanding the specific pathogens and their risk factors is crucial for effective management.
Purpose of the Study:
- To review anaerobic bacteremia episodes in a NICU over 18 years.
- To identify associations between clinical settings, infant age, and specific anaerobic organisms.
Main Methods:
- Retrospective review of 29 clinically significant anaerobic bacteremia episodes.
- Analysis of pathogen type (Gram-positive vs. Gram-negative) and antimicrobial susceptibility in relation to infant age and clinical conditions.
Main Results:
- Gram-positive anaerobes were more frequent in early-onset bacteremia (first 48 hours).
- Gram-negative, penicillin G-resistant anaerobes predominated in infants older than 2 days and those with necrotizing enterocolitis.
- Gram-positive anaerobes were associated with chorioamnionitis.
Conclusions:
- Clinical setting and infant age influence the type of anaerobic bacteria causing bacteremia.
- Empiric antibiotic choices for at-risk newborns should consider these age- and condition-specific patterns.