title: Gut bacteria and late-onset neonatal bloodstream infections in preterm infants.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Pathobiology Research Unit, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA. Electronic address: tarr@wustl.edu.
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.affiliation: Fetal Center, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Warner
mesh_terms: D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007231:Infant, Newborn
keywords: Gram-negative bacteria; Gram-positive bacteria; Gut microbes; Late-onset neonatal bloodstream infections