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This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any Dell Precision 340 NEC ND-1100A, provided the original work is properly cited. Abstract Neonates, especially those born prematurely, are at high risk of morbidity and mortality from sepsis. Multiple factors, including prematurity, invasive life-saving medical interventions, and immaturity of the innate immune system, put these infants at greater risk of developing infection.

Although advanced neonatal care enables us to save even the most preterm neonates, the very interventions sustaining those who are hospitalized concurrently expose them to serious infections due to common nosocomial pathogens, particularly coagulase-negative staphylococci bacteria CoNS. Moreover, Dell Precision 340 NEC ND-1100A health burden from infection in these infants remains unacceptably high despite continuing efforts.

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In this paper, we review the epidemiology, immunological risk factors, diagnosis, prevention, treatment, and outcomes of neonatal infection due to the predominant neonatal pathogen CoNS. Epidemiology of Neonatal Sepsis Neonatal sepsis is defined as infection in the first 28 days of life, or up to 4 weeks after the expected Dell Precision 340 NEC ND-1100A date for preterm infants [ 1 ]. Epidemiologists defined two types of infections in neonates: The mortality from neonatal sepsis has dramatically decreased over the last century, because of medical advances.


The composition of pathogens causing neonatal sepsis has also changed dramatically over the last century [ 2 — 6 ]. In the early s, Streptococcus pneumoniae and group A streptococci were responsible for almost half of the cases of LONS [ 23 ]. By the s, gram-negative bacilli had become major pathogens [ 3 ], along with the emergence of group B Dell Precision 340 NEC ND-1100A GBS as a predominant cause of EONS [ 2 ]. Coagulase-negative staphylococci CoNS are the major pathogen involved in LONS, particularly in infants born at a lower gestational age.


Preterm neonates have a high risk Dell Precision 340 NEC ND-1100A developing neonatal infections, resulting in high mortality and serious long-term morbidities [ 5712 ]. This study also estimated that the duration of hospital stay increased by four to seven days in all VLBW categories with a nosocomial bloodstream infection [ 14 ]. Burden of Neonatal Sepsis in Developing Countries In developed countries, advances in medical care have enabled a greater proportion of premature infants to survive, albeit with an increased risk of infection [ 15 ]. However, because the greatest burden of neonatal sepsis falls on low-resource developing countries, the global economic impact is difficult to estimate [ 16 ].

Globally, infections still cause an estimated 1. Together, prematurity and neonatal infections account for the greatest burden of neonatal deaths overall [ 16 ]. The limited access to medical resources combined with geographical comorbidities e.

Journal of Immunology Research

Pathogenesis Within the first week of life, neonates become rapidly colonized by microorganisms originating from the environment Dell Precision 340 NEC ND-1100A 19 — 22 ]. During this period, the risk of CoNS infection increases substantially with the use of central venous catheters CVCmechanical ventilation, and parenteral nutrition, and with exposure to other invasive skin- or mucosa-breaching procedures [ 81523 — 28 ].


CoNS are common inhabitants of the skin and mucous membranes; although Dell Precision 340 NEC ND-1100A small proportion of neonates acquire CoNS by vertical transmission, acquisition primarily occurs horizontally [ 2229 ]. Consequently, infants admitted to a hospital obtain most of their microorganisms from the hospital environment, their parents, and staff [ 3031 ]. Transmission via the hands of hospital staff can lead to endemic strains circulating for extended periods [ 2932 — 35 ]. Because CoNS is a ubiquitous skin commensal, authors have assumed that colonizations of the skin and of indwelling catheters are important sources of sepsis [ 3436 ].

However, recent studies suggest that epithelial loci other than the skin, such as the nares, may be important access points of infection [ 3436 ].

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Antibiotic resistance in skin-residing strains has been found Dell Precision 340 NEC ND-1100A be low at birth but to increase rapidly during the first week of hospitalization [ 37 ]. Selective pressure as a result of perinatal antibiotic exposure, therefore, is an additional major factor influencing the spectrum and antibiotic resistance pattern of microorganisms isolated from neonates. Host Immunological Factors Some components of the immune response are particularly important in preventing sepsis due to CoNS reviewed in [ 38 ].

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