Impaired cytokine responses to live Staphylococcus epidermidis in preterm infants precede Gram-positive late-onset sepsis

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Abstract

BACKGROUND: Late-onset sepsis (LOS) with Staphylococcus epidermidis is common in preterm infants, but the immunological mechanisms underlying heightened susceptibility are poorly understood.

AIM: To characterise the ontogeny of cytokine responses to live S. epidermidis in preterm infants with and without subsequent Gram-positive LOS.

METHODS: A prospective observational cohort study of preterm infants (<30 weeks gestational age, GA) with blood sampling on days 1, 7, 14, 21 and 28 of life. Cytokine responses in peripheral whole blood stimulated with live S. epidermidis were analysed by 11-plex immunoassay.

RESULTS: Of 129 infants (mean GA 26.2 weeks, mean BW 887g), 23 (17.8%) had confirmed LOS with Gram-positive organisms and 15 (11.6%) infants had clinical sepsis, with median onset at 13 and 15 days, respectively.

CONCLUSIONS: Cytokine responses to live S. epidermidis challenge are impaired in infants with LOS and precede the onset of clinical illness. Quantifying pathogen-specific cytokine responses at day 7 may identify high risk preterm infants at greatest risk of LOS and prospective replication is warranted.

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