Late-onset bloodstream infection and perturbed maturation of the gastrointestinal microbiota in premature infants
Open accessAbstract
BACKGROUND: Late-onset bloodstream infection (LO-BSI) is a common complication of prematurity, and lack of timely diagnosis and treatment can have life-threatening consequences. We sought to identify clinical characteristics and microbial signatures in the gastrointestinal microbiota preceding diagnosis of LO-BSI in premature infants. METHOD: Daily faecal samples and clinical data were collected over two years from 369 premature neonates (<32 weeks gestation). We analysed samples from 22 neonates who developed LO-BSI and 44 matched control infants. Next-generation sequencing of 16S rRNA gene regions amplified by PCR from total faecal DNA was used to characterise the microbiota of faecal samples preceding diagnosis from infants with LO-BSI and controls. Culture of selected samples was undertaken, and bacterial isolates identified using MALDI-TOF. Antibiograms from bloodstream and faecal isolates were compared to explore strain similarity. RESULTS: From the week prior to diagnosis, infants with LO-BSI had higher proportions of faecal aerobes/facultative anaerobes compared to controls. Risk factors for LO-BSI were identified by multivariate analysis. Enterobacteriaceal sepsis was associated with antecedent multiple lines, low birth weight and a faecal microbiota with prominent Enterobacteriaceae. Staphylococcal sepsis was associated with Staphylococcus OTU faecal over-abundance, and the number of days prior to diagnosis of mechanical ventilation and of the presence of centrally-placed lines. In 12 cases, the antibiogram of the bloodstream isolate matched that of a component of the faecal microbiota in the sample collected closest to diagnosis. CONCLUSIONS: The gastrointestinal tract is an important reservoir for LO-BSI organisms, pathogens translocating across the epithelial barrier. LO-BSI is associated with an aberrant microbiota, with abundant staphylococci and Enterobacteriaceae and a failure to mature towards predominance of obligate anaerobes.
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In multiple studies, the composition of the early gut microbiome has been predictive of neonatal sepsis.
“In multiple studies, the composition of the early gut microbiome has been predictive of neonatal sepsis,70,156,157”
From The microbiome and critical illness (2016) · cites this paper as [156]
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- Authors
- Shaw, A. G., Sim, K., Randell, P., Cox, M. J., McClure, Z. E., Li, M.-S., Donaldson, H., Langford, P. R., Cookson, W. O. C. M., Moffatt, M. F., & Kroll, J. S.
- Affiliations
- Imperial College London (GB)
- Corresponding author
- Kroll, J. Simon
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-07-13
- Volume
- 10
- Issue
- 7
- Pages
- e0132923
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4500406
- OpenAlex
- W905687799
- Cited by
- 96
- References
- 42
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 13 · 2023: 12 · 2022: 18 · 2021: 7 · 2020: 11 · 2019: 7 · 2018: 10 · 2017: 8 · 2016: 7 · 2015: 1
- FWCI
- 9.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Wellcome Trust (097117, 096964/Z/11/Z)
- National Institute for Health and Care Research (DRF-2011-04-128, 2011-04-128, NF-SI-0512-10126)
- Imperial College London
- Imperial College Healthcare NHS Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Keywords
- preterm birth, gut microbiota, microbiota maturation, preterm infants, Enterobacteriaceae, Staphylococcus, fecal microbiota, sepsis, mechanical ventilation, central venous catheters, low birth weight, bacterial translocation, antimicrobial susceptibility, risk factors
- MeSH terms
- Feces, Female, Humans, Infant, Newborn, Infant, Premature, Male, Sepsis, Gastrointestinal Tract, Microbiota
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