Late-Onset Infection ✅ Flashcards
How is late-onset neonatal infection acquired?
Either nosocomial (hospital acquired) or community acquired, from the environment or caregivers
What is the most common pathogen causing late-onset neonatal infection?
GBS
What is late-onset GBS infection more often associated with, compared to early-onset?
Meningitis
In what % of cases does late onset GBS infection cause recurrent infections?
1% of cases
What is the most common cause of late-onset sepsis in VLBW (very low birth weight) infants?
Coagulate negative staphylococcus (CONS)
Why is CONS a particularly dangerous pathogen?
It is known to produce a biofilm that facilitates adherence to lines and catheters, and diminishes host immune response and antibiotic effectiveness
What strategies can be employed to reduce the risk of late onset sepsis in preterm infants?
- Strict infection control measures, including strict compliance with hand hygiene
- Strict asepsis during invasive procedures
- Minimising breaches in skin integrity
- Judicious use of parenteral nutrition
- Promotion of enteric feeding with mothers milk
- Rational use of antibiotics
- Limiting dexamethasone and H2 blocker therapy
Give an example of an invasive procedure where it is particularly important to adhere to strict asepsis in preterm infants?
Insertion and subsequent care of central lines and catheters
Give 4 examples of when there may be breaches in skin integrity in preterm infants?
- Electrodes
- Tape
- Venepuncture
- Heel pricks
Why should judicious use of parenteral nutrition be employed in preterm infants?
Prolonged use increases infection risk as it requires central vascular access, and intralipids enhance the growth of lipophilic organisms
Why do intralipids in parenteral nutrition enhance the growth of lipophilic organisms?
They impair the function of white cells
What is involved in the rational use of antibiotics?
Reducing the use of broad spectrum antibiotics
Why is it important to reduce the use of broad spectrum antibiotics in preterm infants?
As they encourage the emergence of antibiotic resistance and fungal sepsis
What is the ideal scenario for antibiotic choice?
Narrow spectrum, and guided by culture sensitivity results
What plays an important role in the development of normal immune defences in the newborn?
The gut
How does the newborns gut play an important role in the development of normal immune defences?
Through complex interaction between gut flora and mother’s milk, with secretory IgA and other immunological factors, and gut-associated lymphoid tissue
What protects against invasion of the gut mucosa by pathogenic organisms?
- The establishment of normal gut flora following vaginal birth
- Breastfeeding
When is gut colonisation abnormal in neonates?
- Following C-section
- With milk feeding
- After antibiotic treatment
How can the risk of neonatal sepsis and necrotising enterocolitis theoretically be reduced in bottle fed infants?
The use of pre- and probiotics, as well as other immunological components such as lactoferrin
Why are probiotics not used as standard?
Because although many studies have been conducted, they have not been shown to be beneficial
