Daily Sepsis Research Analysis

IMPORTANCE: The effects of contact precautions (ie, gowns and gloves) for individual patients colonized with gram-negative (GN) drug-resistant bacteria on sepsis risk in neonates requiring intensive care remain to be clarified. OBJECTIVE: To evaluate the noninferiority of standard hand hygiene disinfection vs standard hygiene disinfection plus extended barrier precautions for infants colonized with third-generation cephalosporins-resistant GN bacteria (3GCR-GNB). DESIGN, SETTING, AND PARTICIPANTS: This cluster-randomized clinical trial was conducted from 2020 to 2023 in 12 German tertiary care neonatal intensive units caring for neonates with high risk for infections with GNB for 24 months, with crossover after 12 months. Follow-up and data curation were completed December 31, 2024, and statistical analysis was finalized on July 31, 2025. INTERVENTION: The intervention was standard hand hygiene disinfection compared with current recommendations, ie, hygiene disinfection plus extended barrier precautions with gowns and gloves for routine care of infants colonized with 3GCR-GNB. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of health care-associated GNB bloodstream infections (BSI) at infant level in all neonates requiring intensive care in the cluster, assuming 5% as noninferiority margin delta; secondary outcomes included transmission rates of 3GCR-GNB and rates of any infection. RESULTS: The primary analysis was based on an overall sample size of 12 sites with crossover at 12 months, making 24 clusters with 9731 neonates. During the standard hand hygiene disinfection periods, 22 of 4699 infants (0.5%) developed GNB BSIs at infant level, compared with 25 of 5032 infants (0.5%) cared for during the extended barrier precaution periods (risk difference [RD], -0.03%; 95% CI, -0.43% to 0.38%; noninferiority P < .001). At least 1 nosocomial transmission with 3GCR-GNB was noted during 41 of 144 months in the intervention period and 54 of 144 months in the control period (RD, -9.03%; 95% CI, -27.79% to 9.74%), with involvement of 116 patients (2.5%) vs 149 patients (3.0%) (RD, -0.44%, 95% CI, -2.47% to 1.58%). The total rate of BSI was 2.1% in neonates during the intervention period vs 2.0% during the control period (RD, 0.12%; 95% CI, -1.39% to 1.64%). CONCLUSIONS AND RELEVANCE: In this cluster-randomized clinical trial, standard hand hygiene disinfection for the care of infants colonized with 3GC-GNB was noninferior to standard hygiene disinfection plus extended barrier precautions. TRIAL REGISTRATION: German Clinical Trials Register identifier: DRKS00019103.

Early-life gut microbiota development is critical for orchestrating mucosal barrier function and immune priming, as disruptions in this process can increase susceptibility to life-threatening diseases such as necrotizing enterocolitis (NEC) and sepsis. This longitudinal multi-omics study of 186 preterm infants (<32 weeks of gestation or <1500 g birth weight) explores the impact of early-life exposures in the neonatal intensive care units (NICUs) on gut microbiota, metabolism, and immune responses. We analyzed 1153 stool samples using quantitative microbial profiling, untargeted metabolomics, and fecal S100A8/A9 (calprotectin) levels. Antibiotic exposure suppressed anaerobic colonization and microbial diversity in a cumulative exposure-dependent manner, with breastmilk feeding partially mitigating these effects. The stool metabolome correlated with microbial colonization, showing antibiotic-driven disruptions in polyamine metabolism linked to anaerobe abundance. Host calprotectin levels followed a biphasic pattern, correlating with microbial diversity and polyamine metabolites. Mediation analysis identified anaerobe suppression and polyamine depletion as key drivers of antibiotic-associated reductions in calprotectin. This study reveals that NICU interventions, particularly antibiotics, reprogram the preterm gut ecosystem and immune response, with anaerobes and polyamines being key mediators linking microbial ecology to immune maturation during early life.

OBJECTIVE: Necrotizing soft-tissue infections (NSTIs) are rapidly progressive infections often characterized by widespread necrosis, sepsis, and multiple organ failure. As such, it is important to individualize treatment decisions using evidence-based prognostication. We aimed to summarize the prognostic association between patient and disease factors and mortality among adult patients with NSTI. DATA SOURCES: We searched three databases (Medline, Embase, and the Cochrane Central Register of Controlled Trials) from inception to September 29, 2025. STUDY SELECTION: We included studies that enrolled adult patients with NSTI and evaluated prognostic factors associated with short-term mortality using adjusted models that account for at least age and comorbidity. DATA EXTRACTION: We pooled effect estimates using a random-effects model. We assessed risk-of-bias using the Quality in Prognosis Studies tool and assessed certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluations methodology. DATA SYNTHESIS: We included 41 observational cohort studies involving 168,261 patients. Studies were predominantly retrospective cohorts. Patient factors with a moderate or high certainty of association with increased mortality include older age, chronic liver disease, chronic kidney disease, high Charlson Comorbidity Index, and immunosuppression. Disease factors with a moderate or high certainty of association with increased mortality include hypotension, bacteremia, acute kidney injury, coagulopathy, thrombocytopenia, and shock. CONCLUSIONS: Several patient and illness factors demonstrate important association with mortality among patients with NSTI. Clinicians should consider these factors in decisions related to escalation of therapy, and counseling patients and family members on potential outcomes.