Liu Xinyu, Zhang Rui, Wang Mengdie, Tang Chuncai, Yang Feifei, Yang Qingjuan, Huang Changyong, Zhang Ying, Ren Zhengmin, Liu Liqiao, Zhou Guozhong, Li Jia
Faculty of Life Science and Technology and the Affiliated Anning First People'S Hospital, Kunming University of Science and Technology, Kunming, 650302, China.
Department of Neonatology, The Affiliated Anning First People'S Hospital of Kunming University of Science and Technology, Kunming, 650302, Yunnan, China.
Gut Pathog. 2025 Mar 27;17(1):16. doi: 10.1186/s13099-025-00693-5.
Gastrointestinal infections represent a significant global health burden, ranking as the second leading cause of mortality among infants and children. Identifying of pathogens causing neonatal gastrointestinal infections has presented tough challenges. This study aimed to summarize the prevalence of common pathogens associated with neonatal gastrointestinal infections through a comprehensive systematic review and meta-analysis of published literature. The last search was performed on January 08, 2025, from databases including EMBASE, PubMed, Cochrane Libary, and Web of Science. The outcome variable was infection rate, and the detection methods used were blood culture, tissue culture, or molecular biology methods. Two researchers independently extracted the research data and evaluated its quality using the JBI Critical Appraisal Tools. Twenty-three studies met the inclusion criteria. The pooled prevalence rates of common pathogens were as follows: Bacteria, including Escherichia (22.2%; 95% CI 8.3-40.4%, I = 98%), Clostridium (21.8%; 95% CI 2.2-53.8%, I = 96%), Klebsiella (19.2%; 95% CI 8.3-33.4%, I = 97%), Staphylococcus (13.6%; 95% CI 6.0-23.7%, I = 91%), Enterococcus (12.4%; 95% CI 1.8-30.3%, I = 96%), and Streptococcus (6.8%; 95% CI 2.5-12.9%, I = 43%). Fungi, including Candida (3.8%; 95% CI 0.6-9.6%, I = 84%). Viruses, including Rotavirus (11.6%; 95% CI 1.0-31.5%, I = 94%) and Adenovirus (4.1%; 95% CI 0.5-11.0%, I = 58%). Peritoneal culture methods demonstrated significantly higher positivity rates compared to other detection methods. Escherichia coli exhibited consistently high positivity rates across the three main detection methods. Klebsiella showed the highest positivity rates among bacterial isolates in both blood and peritoneal cultures. Pathogen detection and prevalence in necrotizing enterocolitis (NEC) cases were markedly higher compared to other conditions. This meta-analysis identifies key pathogens in gastrointestinal infections, including Klebsiella pneumoniae, Escherichia coli, Candida, Rotavirus, Adenovirus, and others that are suspected before clinical sample results are available. It also highlights that intestinal pathogen infections are linked to an increased risk of neonatal necrotizing enterocolitis (NEC) and emphasizes the advantages of peritoneal culture in detecting these infections.
胃肠道感染是一项重大的全球健康负担，是婴幼儿死亡的第二大主要原因。识别引起新生儿胃肠道感染的病原体面临着严峻挑战。本研究旨在通过对已发表文献进行全面的系统综述和荟萃分析，总结与新生儿胃肠道感染相关的常见病原体的流行情况。最近一次检索于2025年1月8日进行，检索数据库包括EMBASE、PubMed、Cochrane图书馆和科学网。结果变量为感染率，使用的检测方法为血培养、组织培养或分子生物学方法。两名研究人员独立提取研究数据，并使用JBI批判性评价工具评估其质量。23项研究符合纳入标准。常见病原体的合并流行率如下：细菌，包括大肠杆菌（22.2%；95%CI 8.3 - 40.4%，I = 98%）、梭菌（21.8%；95%CI 2.2 - 53.8%，I = 96%）、克雷伯菌（19.2%；95%CI 8.3 - 33.4%，I = 97%）、葡萄球菌（13.6%；95%CI 6.0 - 23.7%，I = 91%）、肠球菌（12.4%；95%CI 1.8 - 30.3%，I = 96%）和链球菌（6.8%；95%CI 2.5 - 12.9%，I = 43%）。真菌，包括念珠菌（3.8%；95%CI 0.6 - 9.6%，I = 84%）。病毒，包括轮状病毒（11.6%；95%CI 1.0 - 31.5%，I = 94%）和腺病毒（4.1%；95%CI 0.5 - 11.0%，I = 58%）。与其他检测方法相比，腹腔培养方法显示出显著更高的阳性率。大肠杆菌在三种主要检测方法中均表现出持续较高的阳性率。克雷伯菌在血液和腹腔培养的细菌分离物中阳性率最高。坏死性小肠结肠炎（NEC）病例中的病原体检测和流行率明显高于其他情况。这项荟萃分析确定了胃肠道感染中的关键病原体，包括肺炎克雷伯菌、大肠杆菌、念珠菌、轮状病毒、腺病毒以及其他在临床样本结果出来之前就被怀疑的病原体。它还强调肠道病原体感染与新生儿坏死性小肠结肠炎（NEC）风险增加有关，并强调了腹腔培养在检测这些感染方面的优势。
