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Agostino Pierro, MD; Hendrick K. F. van Saene, MD, PhD, MRCPath; Stephen C. Donnell, FRCS; Julie Hughes, RSCN, RCN; Clare Ewan, BSc; Anthony J. Nunn, BPharm, MRPharmS; David A. Lloyd, MChir, FRCS

Arch Surg. 1996;131(2):176-179.

Abstract
Objective
To explore whether episodes of endogenous septicemias due to microbial translocation are clinically relevant in neonates and infants who are receiving long-term parenteral nutrition (PN).

Design
Prospective observational cohort study of 2 years.

Setting
Neonates and infants who underwent surgical procedures and required PN because of gastrointestinal abnormalities.

Measurements
Surveillance cultures of the oropharynx and gut were obtained at the start of PN and thereafter twice each week. These cultures were processed for all microorganisms, except for coagulase-negative staphylococci, in a semiquantitative manner to detect overgrowth. A blood sample was taken for culture from both the central venous line and peripheral vein on clinical indication only. Microbial translocation was diagnosed when the microorganisms that were isolated from the blood sample were also carried in the throat and/or rectum within the 2 weeks preceding the episode of septicemia.

Main Results
Of 94 infants, 10 (11%) experienced 24 episodes of septicemia (ie, 7.3 septicemic episodes per 1000 days of PN). Six infants experienced 15 episodes of microbial translocation due to enteric microorganisms, including Escherichia coli, Klebsiella, Candida species, and enterococci. Microbial translocation occurred after a median of 58 days of PN (range, 32 to 286 days). The enteric organisms that caused septicemia were always present in the throat and/or rectum and in high concentrations (>10⁵ colony-forming units per gram [ie, overgrowth]) in 60% of the translocation episodes. All but one episode occurred in infants with an abnormal serum bilirubin level (>17 µmol/L [0.99 mg/dL]).

Conclusion
In neonates and infants who are receiving PN, septicemia may be a gut-related phenomenon.

(Arch Surg. 1996;131:176-179)

Author Affiliations
From the Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, England (Dr Pierro), and the Departments of Medical Microbiology/Infection Control (Dr van Saene and Ms Hughes), Paediatric Surgery (Drs Donnell and Lloyd), Dietetics (Ms Ewan), and Pharmacy (Mr Nunn), Royal Liverpool (England) Children's NHS Trust Hospital Alder Hey.

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