title: Factors influencing oral colonization in premature infants.
abstract: BACKGROUND
  Factors influencing the oral flora of premature infants have not been adequately investigated.
  
  
  OBJECTIVE
  To investigate the effects of gestational age and of anti-bacterial therapy on the oral flora of premature infants.
  
  
  METHODS
  Oral cultures were obtained at age 1 day and age 10 days from 65 premature infants, divided into three groups: a) 24 neonates of 30-34 weeks gestation who did not receive ABT, b) 23 neonates of 30-34 weeks gestation who received ABT, and c) 18 neonates < 30 weeks gestation who received ABT.
  
  
  RESULTS
  Oral bacterial colonization increased from day 1 to day 10 of life. In 24-34 week neonates, gestational age did not affect early bacteremia or oral colonization at birth. Neither gestational age nor ABT affected late bacteremia or oral colonization at day 10. In 30-34 week neonates with ABT, the oral flora consisted mainly of non-Escherichia coli gram-negative bacteria, whereas those who did not receive ABT grew mainly alpha-hemolytic streptococci, Klebsiella pneumoniae and E. coli. In neonates < 30 weeks who received ABT the oral flora were mainly coagulase-negative staphylococci. Oral colonization with anaerobes was zero and colonization with fungi was minimal.
  
  
  CONCLUSIONS
  Acquisition of oral bacteria rose from day 1 to day 10 of life, regardless of gestational life or ABT. On day 10 of life, the spectrum of oral bacterial flora changed following ABT and consisted mainly of coagulase-negative Staphylococcus and non-E. coli gram-negative bacteria. Oral colonization showed few fungi but no anaerobes. These microbiologic observations merit attention when empirical anti-microbial therapy is considered in premature infants suspected of having late-onset sepsis.
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel. Makhoul@rambam.health.gov.il
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
authors.forename: Polo
authors.initials: P
authors.lastname: Sujov
authors.forename: Leon
authors.initials: L
authors.lastname: Ardekian
authors.forename: Imad
authors.initials: I
authors.lastname: Kassis
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.forename: Imad
authors.initials: I
authors.lastname: Abu-Elnaa'j
authors.forename: Ada
authors.initials: A
authors.lastname: Tamir
authors.forename: Dov
authors.initials: D
authors.lastname: Laufer
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D005260:Female; D005865:Gestational Age; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009055:Mouth / Q000187:drug effects* / Q000382:microbiology*; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents