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The microbial flora and antimicrobial therapy of neonatal peritonitis
Abstract:
Data from 31 infants with gastrointestinal perforation were analyzed to determine the microorganisms usually present in the peritoneum and blood, and the antibiotic susceptibility of those organisms. Multimicrobial contamination of the peritoneal cavity was present in over one-half of the patients and 23% were found to have mixed aerobic-anaerobic peritoneal flora. Most common organisms were E. coli and Bacteroides species. Blood cultures were positive in 32% of patients, most frequently growing E. coli. Among numerous antibiotics tested, only gentamicin was effective against all Enterobacteriaceae isolated. Clindamycin was 99% effective against Bacteroides species isolated and 90% against other anaerobes. Group D streptococcus was the most frequently isolated gram positive aerobe. Based on these findings, empiric therapy with ampicillin, gentamicin and clindamycin is recommended for neonates with gastrointestinal perforation. Adjustments in therapy for individual patients should be based upon culture and sensitivity data.
Insights
In neonates with gastrointestinal perforation, E. coli and Bacteroides species are common. Empiric antibiotic therapy with ampicillin, gentamicin, and clindamycin is recommended, guided by culture data.
Area of Science:
- Neonatal surgery
- Infectious diseases
- Microbiology
Background:
- Gastrointestinal perforation in infants presents significant challenges.
- Understanding the microbial landscape and antibiotic resistance is crucial for effective treatment.
Purpose of the Study:
- To identify common microorganisms in the peritoneum and blood of infants with gastrointestinal perforation.
- To determine the antibiotic susceptibility patterns of these isolated organisms.
- To guide empiric antibiotic therapy recommendations for this vulnerable population.
Main Methods:
- Analysis of clinical data from 31 infants diagnosed with gastrointestinal perforation.
- Microbiological cultures of peritoneal fluid and blood samples.
- In vitro antibiotic susceptibility testing of isolated bacterial strains.
Main Results:
- Multimicrobial contamination was observed in over 50% of cases, with mixed aerobic-anaerobic flora in 23%.
- Escherichia coli (E. coli) and Bacteroides species were the most frequently isolated organisms.
- Blood cultures were positive in 32% of patients, predominantly with E. coli.
- Gentamicin showed efficacy against all isolated Enterobacteriaceae; Clindamycin was highly effective against Bacteroides species (99%) and other anaerobes (90%).
- Group D Streptococcus was the most common Gram-positive aerobe.
Conclusions:
- Empiric antibiotic therapy for neonates with gastrointestinal perforation should include ampicillin, gentamicin, and clindamycin.
- Treatment regimens should be individualized based on specific culture and sensitivity results.
- This approach aims to optimize outcomes by targeting prevalent pathogens effectively.