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Abstract
Background Neonatal sepsis is a clinical condition with non-specific signs and symptoms caused by invasive pathogens, which is diagnosed through a positive blood culture. It is categorized into early-onset sepsis (≤72 hours of birth) and late-onset sepsis (>72 hours after birth). The gut dysbiosis due to colonization of certain bacteria groups appears to contribute to the development of sepsis. This research investigates the association of opportunistic Enterobacteriaceae pathogens in the gut and the development of neonatal sepsis.
Methods A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline across three databases (Ovid MEDLINE, Pubmed, and Scopus, dated 25th April 2024). The search string used: (‘gut’ OR ‘intestinal’) AND (‘Enterobacteriaceae’ OR ‘gut pathogen’) AND (‘infant’ OR ‘neonate’ OR ‘neonatal’ OR ‘neonatal gut’) AND (‘sepsis’ OR ‘blood infection’). Studies involving the analysis of Enterobacteriaceae gut microbiome of infants with sepsis as compared to those of non-sepsis/healthy controls were included. Studies that are irrelevant at the title/abstract level or without experimental intervention (e.g., reviews) were excluded.
Results Seven studies were identified for qualitative analysis, which amounted to 106 diagnosed sepsis cases. All sepsis cases were diagnosed in preterm infants and the gut microbiome was determined by analyzing faecal samples using microbial culture or culture-independent molecular techniques. Enterobacteriaceae isolates identified from the stools of septic infants from the 7 studies include Klebsiella pneumoniae, Escherichia coli, Serratia marcescens, and Proteus mirabilis. Four of the seven studies supported that the potential pathogen causing sepsis is identified in stools prior to LOS onset, some with an increased relative abundance of the identified pathogens (e.g. E. coli, K. peumoniae) (IDDF2024-ABS-0371 Figure 1). However, the findings on the association between microbial diversity and sepsis were inconsistent.
Conclusions This systematic review revealed the association between the presence of potential sepsis-causing Enterobacteriaceae pathogens in the stool, and the increased relative abundance of that bacteria in the gut with LOS onset. The role of Enterobacteriaceae in sepsis development warrants further investigation. A better understanding of sepsis is crucial for effective control of pathogen colonization and translocation.