Profound pathogen-specific alterations in intestinal microbiota composition precede late onset sepsis in preterm infants.

Neonatal sepsis, subdividid into early onset and late onset sepsis, is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. Note that, in preterm infants, sepsis is difficult to diagnose clinically. They may be relatively asymptomatic until hemodynamic and respiratory collapse is imminent, so, if there is even a remote suspicion of sepsis, they are frequently treated with antibiotics empirically until cultures are sufficiently proven to be negative.

The role of intestinal microbiota in the pathogenesis of late onset sepsis in preterm infants is largely unexplored, but could provide opportunities for microbiota-targeted preventive and therapeutic strategies. The VUMC group hypothesized that microbiota composition changes before the onset of sepsis with causative bacteria that are isolated later in blood culture. In a multicenter case-control study preterm infants born under 30 weeks of gestation were included. Fecal samples collected from the five days preceding late onset sepsis diagnosis, were analyzed by a molecular microbiota detection technique.

Totally, 40 late onset sepsis cases and 40 matched controls were included. Overall, it was found that late onset sepsis could be predicted one day prior clinical onset proving the potential of an early diagnostic biomarker for sepsis in preterm infants.

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