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Optimum Detection of Ureaplasma in Premature Infants

Brand, M. Colleen, PhD*; Mandy, George T., MD*; Arora, Sushrut, PhD; Castro, Eumenia C., MD, PhD; Gordon, Pamela S., BSN§; Hagan, Joseph L., ScD*; Zodin, Amy L., BSN; Weisman, Leonard E., MD*

The Pediatric Infectious Disease Journal: December 2018 - Volume 37 - Issue 12 - p 1294–1298
doi: 10.1097/INF.0000000000001994
Maternal-Neonatal Reports

Background: Ureaplasma spp. is a known risk factor for bronchopulmonary dysplasia in premature infants. Emerging research suggests treatment with azithromycin or clarithromycin in the first days of life (DOLs) reduces bronchopulmonary dysplasia in Ureaplasma spp. positive infants. Side effects of these antibiotics make it imperative to optimize reliable noninvasive screening procedures to identify infants who would benefit from treatment.

Methods: The aim of this study was to determine the best site and time to screen for Ureaplasma spp. in 24- to 34-week premature infants. Oral, nasal, gastric and tracheal cultures were collected and placed immediately in 10B broth media. Polymerase chain reaction verified culture results and identified the Ureaplasma spp.

Results: Cultures yielded a Ureaplasma spp. incidence of 80/168 = 47.6% [95% confidence interval (CI): 40–56]. Nasal cultures had greater sensitivity to detect Ureaplasma spp. than oral cultures (P = 0.008): however, a significant proportion of infants with Ureaplasma spp. would have been missed (12/79 = 15.2%, 95% CI: 8%–25%, P < 0.001) if oral cultures were not obtained. For all sites, the collection at DOL 7–10 were more likely to be positive than the collection at DOL 1–2: however, a significant proportion (5/77 = 6.5%, 95% CI: 2–15, P < 0.001) of infants with Ureaplasma spp. would have been missed if the DOL 1–2 cultures were not obtained.

Conclusions: For optimal Ureaplasma spp. detection in 24- to 34-week premature infants, cultures need to be taken both early and late in the first 10 DOLs both from nasal and oral secretions.

From the *Texas Children’s Hospital Newborn Center, Baylor College of Medicine Pediatrics, Newborn Section

Baylor College of Medicine Pediatrics, Newborn Section

Department of Pathology and Immunology, Texas Children’s Hospital, Baylor College of Medicine

§Texas Children’s Hospital Clinical Research Center

Texas Children’s Hospital Newborn Center, Houston, Texas.

Accepted for publication December 23, 2017.

M.C.B. received the 2015 Lucile Petry Leone Research Grant from Sigma Theta Tau International, Texas Woman’s University Beta Beta Houston chapter. The Texas Children’s Hospital’s Clinical Research Center provided time for P.S.G. to assist with the study. The other authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: M. Colleen Brand, PhD, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin, MC A4480 Houston, TX 77030. E-mail: mcbrand@texaschildrens.org.

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