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The first 300 words of the full text of this section appear below.

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

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CLINICAL MANIFESTATIONS

Neonatal septicemia or meningitis caused by Escherichia coli and other gram-negative bacilli cannot be differentiated clinically from 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, 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.


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ETIOLOGY

E coli strains with the K1 capsular polysaccharide antigen cause approximately 40% of cases of septicemia and 80% of cases of meningitis. 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.


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EPIDEMIOLOGY

The source of E coli and other gram-negative bacterial pathogens in neonatal infections often is the maternal genital tract. The incidence of E coli and ampicillin-resistant E coli infections has increased during the past decade in very low birth weight but not among term infants. Hospital acquisition of gram-negative organisms through person-to-person transmission from nursery personnel and from nursery environmental sites, such as sinks, countertops, and respiratory therapy equipment, can occur, especially among preterm infants who require prolonged neonatal intensive care management. Predisposing factors in neonatal gram-negative bacterial infections include maternal intrapartum infection, gestation less than 37 weeks, low birth weight, . . . [Go to Full Text]


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