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Section 3. Summaries of Infectious Diseases
Escherichia coli and Other Gram-Negative Bacilli
(Septicemia and Meningitis in Neonates)
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Neonatal septicemia or meningitis
caused by
Escherichia coli and other gram-negative bacilli cannot
be differentiated clinically from serious infections caused
by other infectious agents. The first signs of sepsis can be
subtle and similar to signs observed in noninfectious processes.
Clinical signs of septicemia include fever, temperature instability,
heart rate abnormalities, grunting respirations, apnea, cyanosis,
lethargy, irritability, anorexia, vomiting, jaundice, hepatomegaly,
abdominal distention, and diarrhea. Meningitis can occur without
overt signs suggesting central nervous system involvement. Some
gram-negative bacilli, such as
Citrobacter koseri,
Enterobacter sakazakii, and
Serratia marcescens, are associated with brain
abscesses in infants with meningitis caused by these organisms.
ETIOLOGY: Escherichia coli strains with the K1 capsular polysaccharide
antigen cause approximately 40% of cases of septicemia and 80%
of cases of meningitis caused by
E coli. Other important gram-negative
bacilli causing neonatal septicemia include non-K1 strains of
E coli and
Klebsiella species,
Enterobacter species,
Proteus species,
Citrobacter species,
Salmonella species,
Pseudomonas species, and
Serratia species. Nonencapsulated strains of
Haemophilus influenzae and anaerobic gram-negative bacilli are rare causes.
EPIDEMIOLOGY: The source of
E coli and other gram-negative
bacterial pathogens in neonatal infections often is the maternal
genital tract. In addition, hospital acquisition of gram-negative
organisms through person-to-person transmission from nursery
personnel and from nursery environmental sites, such as sinks,
multiple-use solutions, countertops, and respiratory therapy
equipment, has been documented, especially in preterm infants
who require prolonged intensive care management. Predisposing
factors in neonatal gram-negative bacterial infections include
maternal intrapartum infections, gestation <37 weeks, low
birth weight, and prolonged rupture of membranes. Metabolic
abnormalities, such as galactosemia, fetal hypoxia, and acidosis
also have
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Related Article
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Infection Control for Hospitalized Children
Red Book 2006 2006: 153-154.
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