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The establishment of the oral microbiome begins before birth, challenging the long-held belief that the fetal oral cavity is sterile. The presence of oral microbes such as Streptococcus and Fusobacterium in amniotic fluid suggests that microbial exposure may occur in utero, potentially through translocation from the maternal oral or gastrointestinal tract. This early colonization primes the neonatal immune system and sets the stage for subsequent microbial succession. Maternal health,...
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The human microbiota begins developing at birth and undergoes continual change as we age. Infancy marks a critical period of microbial sensitivity, offering a “window of opportunity” during which beneficial microbes help mature the immune system. By age three, children typically develop a more stable and diverse microbial community. Newborns acquire microbes from their immediate environment; vaginal delivery favors maternal vaginal microbes, while cesarean births favor microbes from...
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The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
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Clinical Care Practices Shape Microbiome-Associated Bloodstream Infection Risk in Geographically Distinct NICUs.

Yanping Xu1, Henry Akinbi2,3, Zheng Shen4

  • 1NICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 28, 2026
PubMed
Summary
This summary is machine-generated.

Clinical practices, not just location, shape preterm infant microbiomes and bloodstream infection (BSI) risks. The skin microbiome is a key factor in BSI development, highlighting areas for intervention.

Keywords:
Bloodstream infectionMicrobiomePreterm infants

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Area of Science:

  • Microbiology
  • Neonatal Medicine
  • Infectious Disease Epidemiology

Background:

  • Bloodstream infections (BSI) are a significant cause of illness and death in preterm infants.
  • Geographic variations in BSI pathogens exist, but the underlying causes related to microbial colonization and clinical practices are unclear.

Purpose of the Study:

  • To investigate the relationship between the gut and skin microbiome composition, clinical practices, and BSI epidemiology in preterm infants across two distinct geographic locations.
  • To identify factors influencing microbial colonization and BSI risk in neonatal intensive care units (NICUs).

Main Methods:

  • Prospective cohort study of 127 preterm infants in two NICUs (USA and China).
  • Metagenomic sequencing of stool and skin samples (n=669) collected in the first three weeks of life.
  • Statistical analysis using Generalized Linear Mixed Models and Random Forest to assess associations between microbiome, clinical factors, and BSI.

Main Results:

  • Distinct gut and skin microbiome profiles were observed between the two NICUs, correlating with local BSI patterns (e.g., Staphylococcus aureus in USA, Klebsiella pneumoniae and Enterococcus in China).
  • Skin microbiota showed a strong association with BSI pathogens, suggesting the skin as a potential reservoir.
  • Clinical practices, specifically intravenous catheter use and antibiotic exposure, had a greater impact on microbiome composition than geographic location.

Conclusions:

  • Modifiable clinical care practices significantly influence the developing microbiome in preterm infants, contributing to geographic differences in BSI epidemiology.
  • The skin microbiome is a critical factor in invasive infections, warranting further investigation.
  • Understanding how clinical practices affect pathogen colonization can inform strategies to reduce BSI incidence in vulnerable preterm infants.