title: Sepsis from the gut: the enteric habitat of bacteria that cause late-onset neonatal bloodstream infections.
abstract: BACKGROUND
  Late-onset sepsis is a major problem in neonatology, but the habitat of the pathogens before bloodstream invasion occurs is not well established.
  
  
  METHODS
  We examined prospectively collected stools from premature infants with sepsis to find pathogens that subsequently invaded their bloodstreams, and sought the same organisms in stools of infants without sepsis. Culture-based techniques were used to isolate stool bacteria that provisionally matched the bloodstream organisms, which were then genome sequenced to confirm or refute commonality.
  
  
  RESULTS
  Of 11 children with late-onset neonatal bloodstream infections, 7 produced at least 1 stool that contained group B Streptococcus (GBS), Serratia marcescens, or Escherichia coli before their sepsis episode with provisionally matching organisms. Of 96 overlap comparison subjects without sepsis temporally associated with these cases, 4 were colonized with provisionally matching GBS or S. marcescens. Of 175 comparisons of stools from randomly selected infants without sepsis, 1 contained a GBS (this infant had also served as an overlap comparison subject and both specimens contained provisionally matching GBS). Genome sequencing confirmed common origin of provisionally matching fecal and blood isolates. The invasive E. coli were present in all presepticemic stools since birth, but gut colonization with GBS and S. marcescens occurred closer to time of bloodstream infection.
  
  
  CONCLUSIONS
  The neonatal gut harbors sepsis-causing pathogens, but such organisms are not inevitable members of the normal microbiota. Surveillance microbiology, decolonization, and augmented hygiene might prevent dissemination of invasive bacteria between and within premature infants.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Mike A
authors.initials: MA
authors.lastname: Carl
authors.forename: I Malick
authors.initials: IM
authors.lastname: Ndao
authors.forename: A Cody
authors.initials: AC
authors.lastname: Springman
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Manning
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.forename: Carey-Ann D
authors.initials: CA
authors.lastname: Burnham
authors.forename: Erica Sodergren
authors.initials: ES
authors.lastname: Weinstock
authors.forename: George M
authors.initials: GM
authors.lastname: Weinstock
authors.forename: Todd N
authors.initials: TN
authors.lastname: Wylie
authors.forename: Makedonka
authors.initials: M
authors.lastname: Mitreva
authors.forename: Sahar
authors.initials: S
authors.lastname: Abubucker
authors.forename: Yanjiao
authors.initials: Y
authors.lastname: Zhou
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Stevens
authors.forename: Carla
authors.initials: C
authors.lastname: Hall-Moore
authors.forename: Samuel
authors.initials: S
authors.lastname: Julian
authors.forename: Nurmohammad
authors.initials: N
authors.lastname: Shaikh
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Warner
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
mesh_terms: D016470:Bacteremia / Q000382:microbiology*; D015331:Cohort Studies; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D016680:Genome, Bacterial; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D064307:Microbiota; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology*; D016868:Serratia Infections / Q000453:epidemiology; D012706:Serratia marcescens / Q000235:genetics / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000453:epidemiology; D013292:Streptococcus agalactiae / Q000235:genetics / Q000302:isolation & purification
keywords: Escherichia coli; Serratia marcescens; group B streptococci; septicemia; whole-genome sequencing