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Bacteriologic considerations in perforated necrotizing enterocolitis.

H H Stone, L D Kolb, C E Geheber

    Southern Medical Journal
    |December 1, 1979
    PubMed
    Summary
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    Necrotizing enterocolitis in infants can be lethal when caused by Pseudomonas aeruginosa or beta-hemolytic streptococcus. Early antibiotic therapy should include gentamicin or tobramycin with penicillin.

    Area of Science:

    • Neonatal surgery
    • Pediatric infectious diseases
    • Microbiology

    Background:

    • Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition in infants.
    • Perforated NEC requires surgical intervention and antibiotic treatment.

    Purpose of the Study:

    • To analyze the impact of specific bacterial pathogens on mortality in infants with perforated NEC.
    • To guide antibiotic therapy selection for perforated NEC.

    Main Methods:

    • Retrospective analysis of 61 infants with perforated NEC over ten years.
    • Collection of aerobic and anaerobic cultures from blood, peritoneal cavity, and infections.
    • Correlation of microbial findings with patient outcomes.

    Main Results:

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    • No significant difference in mortality based on anaerobic peritoneal flora or general bacteremia.
    • Peritonitis or bacteremia caused by Pseudomonas aeruginosa or beta-hemolytic streptococcus was uniformly lethal.
    • Staphylococcus aureus bacteremia also showed high mortality.
    • Anaerobic gram-positive cocci in peritoneal cultures were not associated with increased mortality and appeared later in disease course.

    Conclusions:

    • Antibiotic regimens for perforated NEC should initially include gentamicin or tobramycin plus penicillin.
    • Specific pathogens like P. aeruginosa and beta-hemolytic streptococcus necessitate targeted treatment due to high lethality.
    • Empirical antibiotic choices should consider the potential for severe outcomes associated with certain bacterial species.