Body surface cultures in preterm neonates on the first day of life: clinical usefulness


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Abstract

Background: Early-onset neonatal sepsis and pneumonia remain one of the leading causes of neonatal loss. The role of microbiological examination of body surface cultures on the first day of life (DOL) in preterm neonates with high risk for early-onset infections currently remains insufficiently studied. Objective: To estimate the clinical value of microbiological examination of body surface cultures in preterm neonates on the first day of life. Materials and methods: The study included 173 preterm neonates at 24-36 weeks’ gestation admitted directly from the delivery room to the Neonatal Intensive Care Unit (NICU) from January 2020 to April 2021. Microbiological examination was carried out using classical (microscopic, cultural) and innovative methods (proteometric MALDI-TOF-MS analysis). Biological material was taken from three loci (blood culture and two surface cultures, namely oral and rectal swabs). All neonates were divided into two main groups: group I included 43 neonates with positive body surface cultures, group II included 130 neonates with a negative surface culture result. According to their gestational age (GA), the patients were compared in the following subgroups: a) GA<33 weeks (Ia n=10 vs IIa n=47); b) GA=33-36 weeks (Ib n=33 vs IIb n=83). The relationship between surface culture results and the incidence of early neonatal infections (pneumonia, sepsis), complications, as well as severity scores (nSOFA, NEOMOD), inflammation markers, and complications was studied. Results: The subgroups did not differ in anthropometric data, antenatal steroids rates, Apgar, NEOMOD and nSOFA scores. There were no differences in the incidence of early-onset neonatal infections (sepsis and/or pneumonia) (8/10 vs 36/47, in subgroups Ia and IIa, respectively, p>0.05; 11/33 vs 27/83 in subgroups Ib vs IIb, p>0.05). However, additional analysis without regard to commensal bacteria revealed statistically signif icant increase in early-onset neonatal clinical sepsis (EONS) in the neonates <33 weeks GA with positive surface cultures (E. coli and/or Candida sp., and/or Klebsiella sp. and/or Acinetobacter sp. and/or Enterococcus sp.): 4/7 vs 7/47 in Ia and IIa, respectively (p=0.02); this subgroup also had a higher level of C-reactive protein on DOL3 (Me=2.7mg/L, Q1-Q3 1.6-23.4 vs Me=0.95 mg/L, Q1-Q3 0.33-5.0 in subgroups Ia vs IIa, respectively, p=0.08). This pattern was absent in neonates of GA 33-36weeks. Necrotizing enterocolitis (NEC) incidence was found to be higher in all preterm neonates colonized with E. coli and Candida sp. on DOL1 (E. сoli: RR=4.8 (95% CI 1.6-14.7); Candida sp.: RR=9.6 (95% CI3.5-26.7)). Conclusion: Microbiological examination of body surface cultures on DOL1 may be considered as a valuable clinical tool for EONS in preterm neonates born before 33 weeks GA. It can also be regarded as a prognostic method in all premature babies: the absence of E. coli and/or Candida colonization significantly decreases the risk of subsequent development of NEC.

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About the authors

Olga A. Krogh-Jensen

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: olgaborisevich@gmail.com
M.D., Ph.D., Neonatologist at NICU No. 2, Institute of Pediatrics and Neonatology

Irina V. Nikitina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: i_nikitina@oparina4.ru
Dr. Med. Sci., Leading Researcher at the NICU No. 2, Institute of Neonatology and Pediatrics, Associate Professor at the Neonatology Department

Olga N. Bragina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: bragina_medicina@mail.ru
Clinical Resident at the Department of Neonatology, Institute of Neonatology and Pediatrics

Elena L. Isaeva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_isaeva@oparina4.ru
M.D., Ph.D., Senior Researcher at the Laboratory of Microbiology, Institute of Microbiology, Clinical Pharmacology and Epidemiology

Tatiana V. Priputnevich

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: priput1@gmail.com
Dr. Med. Sci., Associate Professor, Director of the Institute of microbiology, antimicrobial therapy and epidemiology

Viktor V. Zubkov

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: victor.zubkov@mail.ru
Dr. Med. Sci., Director of the Institute of Neonatology and Pediatrics

Dmitriy N. Degtyarev

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: d_degtiarev@oparina4.ru
Dr. Med. Sci., Professor, Vice director on Scientific Work; Head of the Neonatal Department, Pediatric Faculty

Anna A. Lenyushkina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a-lenushkina@yandex.ru
MD, Ph.D., Head of the NICU No. 2, Institute of Neonatology and Pediatrics

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