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Dysbiosis anticipating necrotizing enterocolitis in very premature infants.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2015 Feb 01; Vol. 60 (3), pp. 389-97. Date of Electronic Publication: 2014 Oct 23. - Publication Year :
- 2015
-
Abstract
- Background: Necrotizing enterocolitis (NEC) is a devastating inflammatory bowel disease of premature infants speculatively associated with infection. Suspected NEC can be indistinguishable from sepsis, and in established cases an infant may die within hours of diagnosis. Present treatment is supportive. A means of presymptomatic diagnosis is urgently needed. We aimed to identify microbial signatures in the gastrointestinal microbiota preceding NEC diagnosis in premature infants.<br />Methods: Fecal samples and clinical data were collected from a 2-year cohort of 369 premature neonates. Next-generation sequencing of 16S ribosomal RNA gene regions was used to characterize the microbiota of prediagnosis fecal samples from 12 neonates with NEC, 8 with suspected NEC, and 44 controls. Logistic regression was used to determine clinical characteristics and operational taxonomic units (OTUs) discriminating cases from controls. Samples were cultured and isolates identified using matrix-assisted laser desorption/ionization-time of flight. Clostridial isolates were typed and toxin genes detected.<br />Results: A clostridial OTU was overabundant in prediagnosis samples from infants with established NEC (P = .006). Culture confirmed the presence of Clostridium perfringens type A. Fluorescent amplified fragment-length polymorphism typing established that no isolates were identical. Prediagnosis samples from NEC infants not carrying profuse C. perfringens revealed an overabundance of a Klebsiella OTU (P = .049). Prolonged continuous positive airway pressure (CPAP) therapy with supplemental oxygen was also associated with increased NEC risk.<br />Conclusions: Two fecal microbiota signatures (Clostridium and Klebsiella OTUs) and need for prolonged CPAP oxygen signal increased risk of NEC in presymptomatic infants. These biomarkers will assist development of a screening tool to allow very early diagnosis of NEC. Clinical Trials Registration. NCT01102738.<br /> (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Clostridium perfringens genetics
Clostridium perfringens isolation & purification
Continuous Positive Airway Pressure
Enterocolitis, Necrotizing therapy
Female
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases therapy
Klebsiella genetics
Klebsiella isolation & purification
Male
Pregnancy
RNA, Ribosomal, 16S genetics
Sequence Analysis, DNA
Dysbiosis
Enterocolitis, Necrotizing microbiology
Infant, Premature, Diseases microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 60
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 25344536
- Full Text :
- https://doi.org/10.1093/cid/ciu822