Tarr Phillip I, Warner Barbara B
Division of Gastroenterology, Hepatology, and Nutrition, Pathobiology Research Unit, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Fetal Center, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA.
Semin Fetal Neonatal Med. 2016 Dec;21(6):388-393. doi: 10.1016/j.siny.2016.06.002. Epub 2016 Jun 23.
Late-onset neonatal bloodstream infections remain challenges in neonatology. Hand hygiene, line care, and judicious use of indwelling lines are welcome interventions, but might not reduce the incidence of late-onset neonatal bloodstream infections from bacteria originating in the gut. Accumulating data suggest that many pathogens causing late-onset neonatal bloodstream infections are of gut origin, including Gram-positive cocci. In addition to the host-canonical paradigm (i.e., all bacteria have equal risk of invasion and bloodstream infections are functions of variable infant susceptibility), we should now consider bacteria-canonical paradigms, whereby late-onset neonatal bloodstream infection is a function of colonization with a specific subset of bacteria with exceptional invasive potential. In either event, we can no longer be content to reactively approach late-onset neonatal bloodstream infections; instead we need to reduce the occurrences of these infections by broadening our scope of effort beyond line care, and determine the pre-invasive habitat of these pathogens.
晚发型新生儿血流感染仍是新生儿学领域面临的挑战。手部卫生、管路护理以及合理使用留置管路都是值得提倡的干预措施，但可能无法降低源自肠道细菌引起的晚发型新生儿血流感染的发生率。越来越多的数据表明，许多导致晚发型新生儿血流感染的病原体都来自肠道，包括革兰氏阳性球菌。除了宿主经典范式（即所有细菌具有相同的侵袭风险，血流感染是婴儿易感性变化的结果）之外，我们现在还应考虑细菌经典范式，即晚发型新生儿血流感染是由具有特殊侵袭潜力的特定细菌亚群定植所致。无论哪种情况，我们都不能再满足于对晚发型新生儿血流感染采取被动应对的方式；相反，我们需要通过扩大努力范围，超越管路护理，来减少这些感染的发生，并确定这些病原体的侵袭前栖息地。
