Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales in stool surveillance cultures of preterm infants are no risk factor for necrotizing enterocolitis: a retrospective case–control study over 12 years

Author:

Eberhart Martin,Grisold Andrea,Lavorato Michela,Resch Elisabeth,Trobisch Andreas,Resch BernhardORCID

Abstract

Abstract Purpose Microbial dysbiosis has been found preceding necrotizing enterocolitis (NEC) in preterm infants; thus, we aimed to investigate whether there is evidence that neonates with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) positive stool cultures are at higher risk for NEC at the NICU. Methods We included very preterm inborn infants of ≤ 32 weeks of gestational age being fecal carriers of ESBL-E and compared them with 1:1 matched (gestational age, birth weight, gender and year) controls tested negative for ESBL-E in the stool between 2005 and 2016. An association with NEC was defined as the first detection of ESBL-E before or at the time of definite diagnosis of NEC. Results During the study period, we diagnosed 217 infants with a total of 270 ESBL-E. We identified ten different species with ESBL-producing Klebsiella oxytoca being the most common one (46%) followed by Klebsiella pneumoniae (19%), and Citrobacter freundii (17%). Ten out of 217 infants had any kind of NEC in the case group compared to two of the controls (p < 0.01), but only four cases with predefined criteria were associated with NEC ≥ stage IIa (1.8 vs. 0.5%, p = 0.089, OR 4.1, CI95% 0.45–36.6). NEC mortality rate was 2/8 (25%). Conclusions We observed a threefold increase of ESBL-E in stool surveillance cultures during study time and germs were dominated by ESBL-producing Klebsiella spp. There was no evidence that preterm infants colonized with ESBL-E in the stool were at higher risk for definite NEC.

Publisher

Springer Science and Business Media LLC

Subject

Infectious Diseases,Microbiology (medical),General Medicine

Reference36 articles.

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5. Gastmeier P, Geffers C. Stellungnahme des NRZ zur Klarstellung und Erläuterung der DGKH zum Stellenwert von Surveillance‐Systemen in Einrichtungen des Gesundheitswesens Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen. 2012. https://www.nrz-hygiene.de/fileadmin/nrz/Stellungnahme_NRZ_DGKH_12_2012.pdf. Accessed 25 July 2019.

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