Health care-associated infections in critically ill premature newborns: epidemiology, clinical features and diagnostics in modern conditions
AbstractThe aim of this study was to investigate the interrelation between clinical manifestations, laboratory signs of a systemic inflammatory reaction, and features of colonization of the mucous membranes by opportunistic microorganisms in premature infants of various gestational age in cases of health care-associated infections.
Material and methods. During the prospective study 50 premature neonates older than 72 hours of age, received medical treatment in NICU from January 2017 to December 2018 were examined. In such a case of health care-associated infection clinical manifestations, laboratory signs of a systemic inflammatory reaction and features of mucosal colonization were studied.
The results. It was found that both the highest incidence of hospital-acquired infection (HAI) and the maximum of number and frequency laboratory changes (markers of a systemic inflammatory reaction) were noted in neonates of GA ≤28 weeks. They were recorded at the earliest and were prognostically significant markers in all groups of newborns: an increase in the level of procalcitonin and neutrophilia, which were observed on average in half of cases of infections associated with medical care.
In preterm neonates GA >32 weeks, changes in the number of laboratory changes (markers of systemic inflammatory response) were less pronounced. The frequency of an isolated elevation of one of the markers was increasing with gestational age. Among the representatives of opportunistic microorganisms isolated from the pharynx and anus, gram-positive coagulase-negative staphylococci prevailed in preterm infants of any gestational age, most often Staphylococcus epidermidis. Gram-negative flora was represented by various species of the Enterobacteriaceae family with a predominance of Klebsiella pneumoniae in all groups of children.
Identification of fungal microflora was observed only in very premature neonates. In all cases, it was represented by fungi of the species Malassezia furfur. The species diversity of microorganisms at the moment of HAI onset was higher in very premature infants compared to neonates born after 32 weeks, which may indicate a long hospitalization of patients of these groups in the NICU.
Keywords:health care-associated infections, nosocomial infection, preterm newborn, NICU, conditionally pathogenic microorganisms, microbial seeding, systemic inflammatory reaction, systemic inflammatory response syndrome
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Nikitina I.V., Gerasimova A.V., Ivanova L.A., Krogh-Jensen O.A., Isaeva E.L., Lenyushkina A.A., Priputnevich T.V., Degtyarev D.N. Health care-associated infections in critically ill premature newborns: epidemiology, clinical features and diagnostics in modern conditions. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2020; 8 (3): 7-17. DOI: https://doi.org/10.33029/2308-2402-2020-8-3-7-17 (in Russian)
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