Etiological structure of sepsis in extremely premature infants

Abstract

Despite significant advances in modern neonatology, neonatal sepsis remains the main factor in mortality, severe complications, and disability in children. The success of treatment of such children largely depends on timely and adequate antibacterial therapy based on knowledge of the etiology of the disease.

Objective. To determine the features of the modern etiological structure of sepsis in extremely premature infants to improve the effectiveness of their treatment.

Material and methods. The study of the etiology of sepsis was carried out in 24 premature infants with a birth weight of 980 to 1490 g and a gestational age of 26 to 31 weeks. Sowing of biological material (blood, feces and discharge from foci of infection), as well as determination of the sensitivity of pathogens to antibiotics were carried out using generally accepted methods.

Results. Blood cultures were positive in the vast majority of infants. Blood cultures predominantly yielded gram-positive cocci (Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus faecalis, group B Streptococcus), less commonly gram-negative bacteria (Enterobacteriaceae, Pseudomonas aeruginosa, and Neisseria meningitidis), Candida albicans, and intracellular microorganisms: Mycoplasma hominis, Ureaplasma urealyticum, and Chlamidia trachomatis. Most infants had monoinfection. Blood culture associations were detected as combinations of bacteria and/or intracellular microorganisms. Local foci of infection predominantly yielded the same microorganisms as those found in the blood. Most strains of bacterial pathogens were multiresistant to antibiotics.

Conclusion. The etiology of sepsis in extremely premature infants is represented by a wide range of microorganisms with a predominance of gram-positive bacteria and pathogens of intrauterine infection — intracellular pathogens. Blood and biomaterial cultures from infection foci to isolate pathogens causing neonatal sepsis will help determine the choice of antibacterial therapy at all stages of treatment, especially when prescribed early.