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. 2022 Nov 2:10:1002762.
doi: 10.3389/fped.2022.1002762. eCollection 2022.

Impact of a multi-strain probiotic administration on peri-rectal colonization with drug-resistant Gram-negative bacteria in preterm neonates

Marwyn Sowden  1 , Evette van Niekerk  1 , Andre Nyandwe Hamama Bulabula  2 , Angela Dramowski  3 , Andrew Whitelaw  4   5 , Jos Twisk  6 , Mirjam Maria van Weissenbruch  7
Affiliations

Impact of a multi-strain probiotic administration on peri-rectal colonization with drug-resistant Gram-negative bacteria in preterm neonates

Marwyn Sowden et al. Front Pediatr. .

Abstract

Background: Infections caused by drug resistant Gram-negative bacteria (DR-GNB) are a major health concern for hospitalized preterm neonates, globally. The aim of this study was to investigate the effect of a multi-strain probiotic on the incidence of rectal colonization with DR-GNB in preterm neonates.

Methods: A double-blind, placebo-controlled, randomized clinical trial was conducted including 200 neonates, randomly allocated to a multi-strain probiotic (n = 100) or placebo (n = 100).

Results: Fifteen percent of the neonates showed peri-rectal colonization with DR-GNB on the day of enrolment indicating probable maternal-to-neonate (vertical) bacterial transmission or environmental acquisition at time of delivery, with no difference between groups. Acquisition of further DR-GNB colonization was rapid, with an increase from 15% on the day enrolment to 77% by day 7 and 83% by day 14 of life. By day 7 (corresponding to early gut colonization), neonates in the probiotic group were 57% less likely to have peri-rectal DR-GNB colonization [OR: 0.43 (0.20-0.95); p = 0.04] and by day 14 (corresponding to late gut colonization), neonates in the probiotic group were 93% less likely to have peri-rectal DR-GNB colonization [OR: 0.07 (0.02-0.23); p < 0.001].

Conclusion: Hospitalized neonates showed substantial peri-rectal colonization with DR-GNB at enrolment and further rapid acquisition of DR-GNB in the first 2 weeks of life. The use of a multi-strain probiotic was effective in reducing early and late neonatal gut colonization with DR-GNB.

Clinical trial registration: The trial was registered at the Pan African Clinical Trial Registry (PACTR202011513390736).

Keywords: multidrug-resistant Gram negative bacilli; neonate; premature (babies); probiotic; rectal swab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the neonates included in the clinical trial, reasons for non-inclusion, randomization information as well as outcome. ICU, intensive care unit; NICU, neonatal intensive care unit; DR-GNB, drug-resistant Gram-negative bacilli.
Figure 2
Figure 2
(A–C) Drug-resistant Gram-negative pathogens isolated from rectal swabs in preterm neonates by day of swab collection. (A) DR-GNB pathogens isolated from the day of enrolment swab. (B) DR-GNB pathogens isolated from the day 7 swab. (C) DR-GNB pathogens isolated from the day 14 swab.
See this image and copyright information in PMC

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