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Xiang Q, Yan X, Shi X, Huang Y, Li L, Zhong J, Xu T, Tang S, Shi W, Zhou K. Prolonged premature rupture of membranes with increased risk of infection is associated with gut accumulation of Pseudomonas from the environment. Comput Struct Biotechnol J 2024; 23:2851-2860. [PMID: 39100803 PMCID: PMC11296040 DOI: 10.1016/j.csbj.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Background Preterm premature rupture of membranes (PPROM) contributes to over one-third of preterm births, and PPROM infants are more susceptible to infections. However, the risk factors remain poorly understood. We here aim to investigate the association of duration of premature rupture of membranes (PROM) and environmental microbiota with the gut microbiota and infection in PPROM infants. Methods Forty-six premature infants were recruited from two hospitals, and infant fecal and environmental samples were collected. 16 s rRNA sequencing was performed to analyze the fecal and environmental microbiome. Human inflammatory cytokines in cord vein plasma were measured. Results The gut microbiota composition of PPROM infants was different from that of non-PPROM infants, and the microbiome phenotypes were predicted to be associated with a higher risk of infection, further evidenced by the significantly increased levels of IL-6 and IL-8 in cord vein plasma of PPROM infants. The diversity of the gut microbiota in PPROM infants increased significantly as the duration of PROM excessed 12 h, and Pseudomonas contributed significantly to the dynamic changes. The Pseudomonas species in the gut of PPROM infants were highly homologous to those detected in the ward environment, suggesting that prolonged PROM is associated with horizontal transmission of environmental pathogens, leading to a higher risk of infection. Conclusions This study highlights that the duration of PROM is associated with the accumulation of environmental pathogens in the gut of PPROM infants, which is a risk factor for nosocomial infections. Improving environmental hygiene could be effective in optimizing the clinical care of PPROM infants.
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Affiliation(s)
- Quanhang Xiang
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Xudong Yan
- Department of Neonatal Intensive Care Unit, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen 518020, China
| | - Xing Shi
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Yi’e Huang
- Department of Prevention and Healthcare, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518020, China
| | - Lingfeng Li
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Jiacheng Zhong
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Tingting Xu
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Shaohui Tang
- Department of Gastroenterology, the First Affiliated Hospital, Jinan University, Guangzhou 510632, China
| | - Wei Shi
- Department of Obstetrics, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen 518020, China
| | - Kai Zhou
- Shenzhen Institute of Respiratory Diseases, the Second Clinical Medical College (Shenzhen People's Hospital), Jinan University ; The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen 518000, China
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Sawale M, Ozadali F, Valentine CJ, Benyathiar P, Drolia R, Mishra DK. Impact of bovine lactoferrin fortification on pathogenic organisms to attenuate the risk of infection for infants. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parsons AA, Rule ARL, Cheruiyot D, Sleeth C, Ronoh C, Mutai D, Schaffzin J, Kamath-Rayne BD. Perceptions of barriers and facilitators to disinfection of basic neonatal resuscitation equipment in a rural hospital in Kenya: A qualitative study. Midwifery 2021; 104:103200. [PMID: 34844179 DOI: 10.1016/j.midw.2021.103200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Allison A Parsons
- Division of Critical Care, Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States.
| | - Amy R L Rule
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Divisions of Neonatology and Hospital Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States
| | | | | | | | | | - Joshua Schaffzin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Beena D Kamath-Rayne
- Division of Global Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
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Wong H, Eso K, Ip A, Jones J, Kwon Y, Powelson S, de Grood J, Geransar R, Santana M, Joffe AM, Taylor G, Missaghi B, Pearce C, Ghali WA, Conly J. Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review. Syst Rev 2015; 4:152. [PMID: 26546048 PMCID: PMC4636845 DOI: 10.1186/s13643-015-0131-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment. METHODS We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality. RESULTS We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted. CONCLUSIONS With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.
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Affiliation(s)
- Holly Wong
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Katherine Eso
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Ada Ip
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Jessica Jones
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Yoojin Kwon
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Susan Powelson
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Jill de Grood
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Rose Geransar
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Maria Santana
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Bayan Missaghi
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Craig Pearce
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9
| | - William A Ghali
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - John Conly
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9. .,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Snyder Institute for Chronic Diseases, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
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Bizzarro MJ, Ehrenkranz RA, Gallagher PG. Concurrent bloodstream infections in infants with necrotizing enterocolitis. J Pediatr 2014; 164:61-6. [PMID: 24139563 DOI: 10.1016/j.jpeds.2013.09.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/16/2013] [Accepted: 09/06/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the incidence, microbiology, risk factors, and outcomes related to bloodstream infections (BSIs) concurrent with the onset of necrotizing enterocolitis (NEC). STUDY DESIGN We performed a retrospective review of all cases of NEC in a single center over 20 years. BSI was categorized as "NEC-associated" if it occurred within 72 hours of the diagnosis of NEC and "post-NEC" if it occurred >72 hours afterwards. Demographics, hospital course data, microbiologic data, and outcomes were compared via univariate and multivariate analyses. RESULTS NEC occurred in 410 infants with mean gestational age and birth weight of 29 weeks and 1290 g, respectively; 158 infants were diagnosed with at least one BSI; 69 (43.7%) with NEC-associated BSI, and 89 (56.3%) with post-NEC BSI. Two-thirds of NEC-associated BSI were due to gram-negative bacilli compared with 31.9% of post-NEC BSI (OR: 4.27; 95% CI: 2.02, 9.03) and 28.5% of all BSI in infants without NEC (OR: 5.02; 95% CI: 2.82, 8.96). Infants with NEC-associated BSI had higher odds of requiring surgical intervention (aOR: 3.51; 95% CI: 1.98, 6.24) and death (aOR: 2.88; 95% CI: 1.39, 5.97) compared with those without BSI. CONCLUSIONS BSI is a common, underappreciated complication of NEC occurring concurrent with the onset of disease and afterwards. The microbiologic etiology of NEC-associated BSI is different from post-NEC and late-onset BSI in infants without NEC with a predominance of gram-negative bacilli. Infants with NEC-associated BSI are significantly more likely to die than those with post-NEC BSI and NEC without BSI.
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Affiliation(s)
- Matthew J Bizzarro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
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Grishin A, Papillon S, Bell B, Wang J, Ford HR. The role of the intestinal microbiota in the pathogenesis of necrotizing enterocolitis. Semin Pediatr Surg 2013; 22:69-75. [PMID: 23611609 PMCID: PMC3647029 DOI: 10.1053/j.sempedsurg.2013.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Development of necrotizing enterocolitis (NEC) requires a susceptible host, typically a premature infant or an infant with congenital heart disease, enteral feedings and bacterial colonization. Although there is little doubt that microbes are critically involved in the pathogenesis of NEC, the identity of specific causative pathogens remains elusive. Unlike established normal adult gut microbiota, which is quite complex, uniform, and stable, early postnatal bacterial populations are simple, diverse, and fluid. These properties complicate studies aimed at elucidating characteristics of the gut microbiome that may play a role in the pathogenesis of NEC. A broad variety of bacterial, viral, and fungal species have been implicated in both clinical and experimental NEC. Frequently, however, the same species have also been found in physiologically matched healthy individuals. Clustered outbreaks of NEC, in which the same strain of a suspected pathogen is detected in several patients suggest, but do not prove, a causative relationship between the specific pathogen and the disease. Studies in Cronobacter sakazakii, the best characterized NEC pathogen, have demonstrated that virulence is not a property of a bacterial species as a whole, but rather a characteristic of certain strains, which may explain why the same species can be pathogenic or non-pathogenic. The fact that a given microbe may be innocuous in a full-term, yet pathogenic in a pre-term infant has led to the idea of opportunistic pathogens in NEC. Progress in understanding the infectious nature of NEC may require identifying specific pathogenic strains and unambiguously establishing their virulence in animal models.
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Molina-Cabrillana J, Artiles-Campelo F, Dorta-Hung E, Santana-Reyes C, Quori A, Lafarga-Capuz B, Hernández-Vera JR. Outbreak of Pseudomonas aeruginosa infections in a neonatal care unit associated with feeding bottles heaters. Am J Infect Control 2013; 41:e7-9. [PMID: 23369317 DOI: 10.1016/j.ajic.2012.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
This report describes an outbreak caused by Pseudomonas aeruginosa in a neonatal care unit possibly linked to feeding bottles heaters. Infection control measures were undertaken such as reinforcement of contact isolation precautions, environmental microbiologic sampling, educational sessions on hand hygiene, and use of sterilized water to refill feeding bottles heaters. The sustained eradication of P aeruginosa isolates after implementing control measures on feeding bottles heaters strongly suggests those as the source of the outbreak.
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Abstract
OBJECTIVES Storage of human milk by freezing has been recommended for long-term storage. The present study analyzed the bactericidal activity of human milk on Escherichia coli and Pseudomonas aeruginosa and determined the changes in bactericidal activity following freezing at -20°C and -80°C for 1 month and 3 months. METHODS Forty-eight milk samples were collected from 48 lactating mothers. Each sample was divided into 10 aliquots. Two of the samples were processed immediately and the others were stored at both -20°C and -80°C until analysis after 1 month and 3 months of freezing. RESULTS All of the fresh milk samples showed bactericidal activity against E coli and P aeruginosa. Freezing at -20°C for 1 month did not cause statistically significant alteration in bactericidal activity (P > 0.017), whereas storage for 3 months lowered the degree of bactericidal activity significantly (P < 0.017) against E coli. Bactericidal activity was protected when the samples were stored at -80°C. There was no statistically significant difference in the bactericidal activity of human milk against E coli between freezing at -20°C and -80°C for 1 month (P > 0.017); however, when milk was stored for 3 months, -80°C was significantly more protective (P < 0.017). Freezing at -20°C and -80°C for 1 month and 3 months did not cause any significant change in bactericidal activity against P aeruginosa (P > 0.05). CONCLUSIONS Storage by freezing at -80°C is more appropriate to keep bactericidal capacity of stored human milk >1 month if affordable and available, especially in intensive care settings.
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Jefferies JMC, Cooper T, Yam T, Clarke SC. Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources. J Med Microbiol 2012; 61:1052-1061. [DOI: 10.1099/jmm.0.044818-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J. M. C. Jefferies
- Health Protection Agency, Southampton, UK
- Molecular Microbiology Group, Academic Unit of Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T. Cooper
- Infection Prevention Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T. Yam
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Infection Prevention Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S. C. Clarke
- Molecular Microbiology Group, Academic Unit of Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Ran-Ressler RR, Khailova L, Arganbright KM, Adkins-Rieck CK, Jouni ZE, Koren O, Ley RE, Brenna JT, Dvorak B. Branched chain fatty acids reduce the incidence of necrotizing enterocolitis and alter gastrointestinal microbial ecology in a neonatal rat model. PLoS One 2011; 6:e29032. [PMID: 22194981 PMCID: PMC3237582 DOI: 10.1371/journal.pone.0029032] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/19/2011] [Indexed: 01/05/2023] Open
Abstract
Introduction Branched chain fatty acids (BCFA) are found in the normal term human newborn's gut, deposited as major components of vernix caseosa ingested during late fetal life. We tested the hypothesis that premature infants' lack of exposure to gastrointestinal (GI) BCFA is associated with their microbiota and risk for necrotizing enterocolitis (NEC) using a neonatal rat model. Methods Pups were collected one day before scheduled birth. The pups were exposed to asphyxia and cold stress to induce NEC. Pups were assigned to one of three experimental treatments. DF (dam-fed) ; Control, hand-fed rat milk substitute ; BCFA, hand-fed rat milk substitute with 20%w/w BCFA. Total fat was equivalent (11%wt) for both the Control and BCFA groups. Cecal microbiota were characterized by 16S rRNA gene pyrosequencing, and intestinal injury, ileal cytokine and mucin gene expression, interleukin-10 (IL-10) peptide immunohistochemistry, and BCFA uptake in ileum phospholipids, serum and liver were assessed. Results NEC incidence was reduced by over 50% in the BCFA group compared to the Control group as assessed in ileal tissue; microbiota differed among all groups. BCFA-fed pups harbored greater levels of BCFA-associated Bacillus subtilis and Pseudomonas aeruginosa compared to Controls. Bacillus subtilis levels were five-fold greater in healthy pups compared to pups with NEC. BCFA were selectively incorporated into ileal phospholipids, serum and liver tissue. IL-10 expression increased three-fold in the BCFA group versus Controls and no other inflammatory or mucosal mRNA markers changed. Conclusion At constant dietary fat level, BCFA reduce NEC incidence and alter microbiota composition. BCFA are also incorporated into pup ileum where they are associated with enhanced IL-10 and may exert other specific effects.
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Affiliation(s)
- Rinat R. Ran-Ressler
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, New York, United States of America
| | - Ludmila Khailova
- Department of Pediatrics, University of Arizona, Tucson, Arizona, United States of America
| | - Kelly M. Arganbright
- Department of Pediatrics, University of Arizona, Tucson, Arizona, United States of America
| | | | - Zeina E. Jouni
- Mead Johnson Nutrition, Evansville, Indiana, United States of America
| | - Omry Koren
- Department of Microbiology, Cornell University, Ithaca, New York, United States of America
| | - Ruth E. Ley
- Department of Microbiology, Cornell University, Ithaca, New York, United States of America
| | - J. Thomas Brenna
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, New York, United States of America
- * E-mail: (JTB); (BD)
| | - Bohuslav Dvorak
- Department of Pediatrics, University of Arizona, Tucson, Arizona, United States of America
- * E-mail: (JTB); (BD)
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Crivaro V, Di Popolo A, Caprio A, Lambiase A, Di Resta M, Borriello T, Scarcella A, Triassi M, Zarrilli R. Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures. BMC Infect Dis 2009; 9:70. [PMID: 19463153 PMCID: PMC2692859 DOI: 10.1186/1471-2334-9-70] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa, a non-fermentative, gram-negative rod, is responsible for a wide variety of clinical syndromes in NICU patients, including sepsis, pneumonia, meningitis, diarrhea, conjunctivitis and skin infections. An increased number of infections and colonisations by P. aeruginosa has been observed in the neonatal intensive care unit (NICU) of our university hospital between 2005 and 2007. METHODS Hand disinfection compliance before and after an educational programme on hand hygiene was evaluated. Identification of microrganisms was performed using conventional methods. Antibiotic susceptibility was evaluated by MIC microdilution. Genotyping was performed by PFGE analysis. RESULTS The molecular epidemiology of Pseudomonas aeruginosa in the NICU of the Federico II University hospital (Naples, Italy) and the infection control measures adopted to stop the spreading of P. aeruginosa in the ward were described. From July 2005 to June 2007, P. aeruginosa was isolated from 135 neonates and caused severe infections in 11 of them. Macrorestriction analysis of clinical isolates from 90 neonates identified 20 distinct genotypes, one major PFGE type (A) being isolated from 48 patients and responsible for 4 infections in 4 of them, four other distinct recurrent genotypes being isolated in 6 to 4 patients. Seven environmental strains were isolated from the hand of a nurse and from three sinks on two occasions, two of these showing PFGE profiles A and G identical to two clinical isolates responsible for infection. The successful control of the outbreak was achieved through implementation of active surveillance of healthcare-associated infections in the ward together with environmental microbiological sampling and an intense educational programme on hand disinfection among the staff members. CONCLUSION P. aeruginosa infections in the NICU were caused by the cross-transmission of an epidemic clone in 4 neonates, and by the selection of sporadic clones in 7 others. An infection control programme that included active surveillance and strict adherence to hand disinfection policies was effective in controlling NICU-acquired infections and colonisations caused by P. aeruginosa.
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Affiliation(s)
- Valeria Crivaro
- Dipartimento di Scienze Mediche Preventive, Sezione di Igiene, Università Federico II, Napoli, Italy.
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Brannon MK, Davis JM, Mathias JR, Hall CJ, Emerson JC, Crosier PS, Huttenlocher A, Ramakrishnan L, Moskowitz SM. Pseudomonas aeruginosa Type III secretion system interacts with phagocytes to modulate systemic infection of zebrafish embryos. Cell Microbiol 2009; 11:755-68. [PMID: 19207728 DOI: 10.1111/j.1462-5822.2009.01288.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pseudomonas aeruginosa is an opportunistic human pathogen that can cause serious infection in those with deficient or impaired phagocytes. We have developed the optically transparent and genetically tractable zebrafish embryo as a model for systemic P. aeruginosa infection. Despite lacking adaptive immunity at this developmental stage, zebrafish embryos were highly resistant to P. aeruginosa infection, but as in humans, phagocyte depletion dramatically increased their susceptibility. The virulence of an attenuated P. aeruginosa strain lacking a functional Type III secretion system was restored upon phagocyte depletion, suggesting that this system influences virulence through its effects on phagocytes. Intravital imaging revealed bacterial interactions with multiple blood cell types. Neutrophils and macrophages rapidly phagocytosed and killed P. aeruginosa, suggesting that both cell types play a role in protection against infection. Intravascular aggregation of erythrocytes and other blood cells with resultant circulatory blockage was observed immediately upon infection, which may be relevant to the pathogenesis of thrombotic complications of human P. aeruginosa infections. The real-time visualization capabilities and genetic tractability of the zebrafish infection model should enable elucidation of molecular and cellular details of P. aeruginosa pathogenesis in conditions associated with neutropenia or impaired phagocyte function.
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Affiliation(s)
- Mark K Brannon
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Achour W, Abbassi MS, Cherif A, Jabnoun S, Khrouf N, Ben Hassen A. Épidémie d'infection respiratoire à Pseudomonas aeruginosa O:12 résistante à l'imipénème dans une unité de réanimation néonatale à Tunis. ACTA ACUST UNITED AC 2006; 54:596-9. [PMID: 17030453 DOI: 10.1016/j.patbio.2006.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Accepted: 07/24/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Investigation of an outbreak caused by an imipenem-resistant Pseudomonas aeruginosa strain and research of its hospital reservoir. PATIENTS AND METHODS Nine strains isolated from protected tracheal specimens during 14 weeks (October 2004 to January 2005) from 8 infants, and one strain from vacuum interrupter were studied. Epidemiological study was investigated by determination of antibiotics susceptibility, serotyping and Pulsed-field gel electrophoresis (PFGE). RESULTS Strains were of O:12 serotype, they have the same antibiotype characterised by imipenem resistance. Strains were indistinguishable or closely related as determined by PFGE. The common source of P. aeruginosa O:12 strains was not determined, however eradication of the epidemic strain was obtained by amelioration of hygiene conditions and the change of disinfectors. CONCLUSION Outbreak of respiratory infections due to an imipenem-resistant P. aeruginosa O:12. The common source of the epidemic strain was not determined.
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Affiliation(s)
- W Achour
- Service des laboratoires, centre national de greffe de moelle osseuse, rue Djebel-Lakdhar, Bab-Saadoun, 1006 Tunis, Tunisie
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Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365:1175-88. [PMID: 15794973 DOI: 10.1016/s0140-6736(05)71881-x] [Citation(s) in RCA: 433] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hospital-born babies in developing countries are at increased risk of neonatal infections because of poor intrapartum and postnatal infection-control practices. We reviewed data from developing countries on rates of neonatal infections among hospital-born babies, range of pathogens, antimicrobial resistance, and infection-control interventions. Reported rates of neonatal infections were 3-20 times higher than those reported for hospital-born babies in industrialised countries. Klebsiella pneumoniae, other gram-negative rods (Escherichia coli, Pseudomonas spp, Acinetobacter spp), and Staphylococcus aureus were the major pathogens among 11,471 bloodstream isolates reported. These infections can often present soon after birth. About 70% would not be covered by an empiric regimen of ampicillin and gentamicin, and many might be untreatable in resource-constrained environments. The associated morbidity, mortality, costs, and adverse effect on future health-seeking behaviour by communities pose barriers to improvement of neonatal outcomes in developing countries. Low-cost, "bundled" interventions using systems quality improvement approaches for improved infection control are possible, but should be supported by evidence in developing country settings.
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Affiliation(s)
- Anita K M Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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Schutze GE, Gilliam CH, Jin S, Cavenaugh CK, Hall RW, Bradsher RW, Jacobs RF. Use of DNA fingerprinting in decision making for considering closure of neonatal intensive care units because of Pseudomonas aeruginosa bloodstream infections. Pediatr Infect Dis J 2004; 23:110-4. [PMID: 14872174 DOI: 10.1097/01.inf.0000109222.90464.aa] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bloodstream infections with Pseudomonas aeruginosa have been well-described in neonatal intensive care units (NICU) and have resulted in the temporary closure of some nurseries to new admissions. Nosocomial transmission of these infections has been verified by fingerprint analysis of the isolates. We utilized molecular fingerprinting to identify the source of bloodstream infections in an NICU and used this information to apply infection control measures that allowed the nursery to stay open and continue to accept referrals. METHODS In June 1998 three premature infants transferred to our hospital (Hospital A) from Hospitals B and C had bloodstream infections with P. aeruginosa. Subsequently one additional neonate transferred from Hospital B was colonized with P. aeruginosa. Random amplification of polymorphic deoxyribonucleic acid (RAPD) was performed on the four isolates. All transfers from Hospital B were cultured, and surveillance programs were instituted in Hospitals A and B. Targeted infection control measures for all transfers were implemented. RESULTS The four isolates were the same clone by RAPD. Investigation of the environment in Hospital A did not identify any source of the organism. Surveillance cultures on 49 neonates at Hospital A revealed only one patient colonized at an endotracheal tube. This patient was also a transfer from Hospital B. Results from Hospital B identified 4 of 40 (10%) neonates colonized. All isolates were clones identical with the bloodstream isolates from the neonates with bloodstream infections. Infection control measures for all babies transferred from Hospital B resulted in no new cases of P. aeruginosa bacteremia during the next 5 years. CONCLUSIONS The use of molecular fingerprinting of isolates of P. aeruginosa allowed for a prompt and directed infection control plan to be implemented in Hospitals A and B. It also allowed the NICU in Hospital A to continue to accept referrals from other hospitals and to implement a targeted infection control plan for patients transferred from Hospital B.
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Affiliation(s)
- Gordon E Schutze
- Department of Pediatrics, School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cordero L, Sananes M, Coley B, Hogan M, Gelman M, Ayers LW. Ventilator-associated pneumonia in very low-birth-weight infants at the time of nosocomial bloodstream infection and during airway colonization with Pseudomonas aeruginosa. Am J Infect Control 2000; 28:333-9. [PMID: 11029131 DOI: 10.1067/mic.2000.109884] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To study retrospectively the incidence of ventilator-associated pneumonia (VAP) at the time of Pseudomonas aeruginosa nosocomial bloodstream infection (BSI) and at the time of P aeruginosa airway colonization. MATERIALS AND METHODS Fifteen very low-birth-weight infants who had P aeruginosa BSI and 33 others who did not but who had P aeruginosa airway-colonization were studied. We correlated clinical data, blood cultures (BCs), and tracheal cultures (TCs) with radiologic findings from radio-graphs taken within 2 days before, the day of, and 1 day after BCs or TCs were first positive for P aeruginosa. Chest radiographs were graded by using semiquantitative scores for bronchopulmonary dysplasia and for pneumonia. RESULTS Mean birth weight, gestational age, and age when BC or TC became positive were similar for patients with BSI and colonization. At the time of BSI, 2 infants had airway colonization with P aeruginosa; the TCs of the remaining 13 grew P aeruginosa as a new pathogen. Thirteen of 15 patients with BSI, but none of 33 infants with colonization, died within 2 days of positive BC. VAP was diagnosed in 13 of 15 patients with BSI and in 3 of 33 infants with colonization. CONCLUSION Mechanically ventilated very low-birth-weight infants whose TCs yield P aeruginosa but whose BCs remain negative infrequently have VAP are presumed airway-colonized and are expected to survive. Conversely, VAP is likely to be found when BCs and TCs simultaneously grow P aeruginosa, and high mortality is anticipated.
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Affiliation(s)
- L Cordero
- Newborn Services and the Department of Pediatrics, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA
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Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, Saiman L. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000; 343:695-700. [PMID: 10974133 DOI: 10.1056/nejm200009073431004] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nosocomial infections due to Pseudomonas aeruginosa have been well described, but the environmental reservoir of the organism varies. We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa infection among infants in a neonatal intensive care unit that was associated with carriage of the organisms on the hands of health care workers. METHODS In August 1998, colonization or infection with P. aeruginosa was identified in six infants. Surveillance cultures for P. aeruginosa were obtained from the other 27 infants in the unit, and possible environmental reservoirs were also assessed. The hands of health care workers were inspected and cultured, and risk factors for P. aeruginosa colonization were evaluated. Isolates were analyzed for clonality by pulsed-field gel electrophoresis. RESULTS Surveillance cultures showed that three additional infants were colonized with P. aeruginosa. Cultures of environmental specimens were negative, but cultures of the hands of 10 of 165 health care workers (6 percent) were positive for P. aeruginosa. Increasing age (P=0.05) and a history of the use of artificial fingernails or nail wraps (P=0.03) were both risk factors for colonization of the hands. From January 1997 to August 1998, 49 infants were infected or colonized with P. aeruginosa. Pulsed-field gel electrophoresis demonstrated that 17 of these infants and 1 health care worker who had onychomycosis had the same clone. Infants who were exposed to this health care worker in August 1998 were at greater risk of having this clone than infants who were not exposed to this health care worker (odds ratio, 41.2; 95 percent confidence interval, 1.8 to 940.0; P=0.006). CONCLUSIONS An increased rate of infection and colonization with P. aeruginosa among infants in neonatal intensive care units should be investigated by assessing potential reservoirs, including environmental sources as well as patients and health care workers.
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Affiliation(s)
- M Foca
- Department of Pediatrics, New York-Presbyterian Hospital and Columbia-Presbyterian Medical Center, New York, USA
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Garland SM, Mackay S, Tabrizi S, Jacobs S. Pseudomonas aeruginosa outbreak associated with a contaminated blood-gas analyser in a neonatal intensive care unit. J Hosp Infect 1996; 33:145-51. [PMID: 8808748 DOI: 10.1016/s0195-6701(96)90099-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over a 10 month period in a neonatal intensive care unit there was an outbreak of infection caused by Pseudomonas aeruginosa (resistant to ticarcillin, timentin) which involved 24 newborns. There was extensive morbidity and mortality (38%) associated with the infections, which presented as septicaemia (N = 6) (five succumbed and four had coexisting pneumonia), pneumonia (N = 6), meningitis (one, died), conjunctivitis (N = 1), otitis externa (N = 1), conjunctivitis plus otitis externa (N = 1). In addition there were two pseudosepticaemias and six colonized infants, three of whom were treated for the presence of P. aeruginosa in endotracheal aspirates. There was always at least one baby colonized or infected with P. aeruginosa during the outbreak. Environmental surveillance and genomic DNA fingerprinting of isolates identified the blood gas analyzer port as the likely reservoir for the outbreak. Further spread of the organism did not occur after commencement of staff education on vigilant and careful handwashing, especially after use of the blood-gas analyser.
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Affiliation(s)
- S M Garland
- Department of Microbiology, Royal Women's Hospital, Carlton, Victoria, Australia
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