CLINICAL IMPACT OF ABNORMAL GUT FLORA IN INFANTS RECEIVING PARENTERAL-NUTRITION

Objective Illness is associated with the carriage of abnormal flora (a erobic Gram-bacilli except E. coli) in the oropharynx and rectum. The aim of this study was to investigate whether carriage of abnormal flor a is associated with increased risk of sepsis and septicemia in surgic al newborn infants. Methods A 2-year prospective study was carried out on 94 consecutive newborn infants requiring parenteral nutrition (PN) for gastrointestinal abnormalities. Throat and rectal swabs were take n on day 1 of PN and twice weekly. Patients were divided into two grou ps: abnormal flora (AF; n = 41) and normal flora (NF; n = 53). Sepsis was defined as clinical features of generalized inflammation requiring blood culture. Septicemia was the combination of sepsis and positive blood culture. Results Among the infants carrying abnormal flora Pseud omonas and Enterobacter spp, predominated. Duration of PN (AF median 3 0 days; NF median 9 days), incidence of sepsis (AF 29%; NF 6%), and se pticemia (AF 22%; NF 2%) were significantly greater in the group of in fants with abnormal flora. Surveillance cultures allow the detection o f a subset of infants on PN at high risk of sepsis and septicemia. The degree of gut dysfunction related to the severity of underlying disea se determines the duration of PN and the development of abnormal flora . The association between abnormal carriage and increased risk of seps is and septicemia may be because of the intestinal endotoxin pool know n to cause liver impairment and consequent suppression of systemic imm unity.