Liver enzyme abnormalities in Gram-negative bacteremia of premature infants

Raanan Shamir, Ayala Maayan-Metzger, Yoram Bujanover, Shai Ashkenazi, Gabriel Dinari, Lea Sirota

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Background. Hyperbilirubinemia and liver enzyme abnormalities are commonly observed in sepsis. However, the frequency in premature neonates and the specific relation to Gram-negative bacteria are not known. Patients and methods. Charts of all preterm infants who had positive blood cultures for either Gram-negative bacteria or coagulase-negative staphylococci were reviewed. Neonates with Gram-negative bacteremia (n = 54) were compared with neonates with coagulase-negative staphylococcal bacteremia (n = 31). In addition infants with Gram-negative bacteremia and elevated liver enzymes (n = 25) were compared with infants with Gram-negative bacteremia and normal liver enzymes (n = 29). Results. Liver enzyme abnormalities accompanied 46.3% (25 of 54) of Gram-negative bacteremia and 12.9% (4 of 31) of episodes of coagulase-negative staphylococcal bacteremia (P = 0.002), Serum concentrations of liver enzymes were significantly higher in infants with Gram-negative bacteremia than in those with coagulase-negative staphylococcal bacteremia (P < 0.0001), but no difference in alkaline phosphatase serum values was observed. Infants with Gram-negative bacteremia and elevated liver enzymes were not fed for a longer period than infants with Gram-negative bacteremia and normal liver enzymes (7.3 ± 6.3 days vs. 4.0 ± 4.3 days, P = 0.03), and this was accompanied by significant conjugated hyperbilirubinemia (P < 0.0001). Ventilation, total parenteral nutrition and medications were not responsible for the observed differences. Klebsiella pneumoniae bacteremia was commonly associated with elevated liver enzymes (12 of 18), whereas none of the infants with Pseudomonas aeruginosa bacteremia had elevated liver enzymes. Conclusions. Gram-negative bacteremia is commonly associated with cholestasis in premature neonates. Liver enzyme abnormalities are more common than elevated conjugated bilirubin, not all Gram-negative bacteria have the same effect and the lack of enteral feeding seems to play a more significant role than the administration of parenteral nutrition.

Original languageEnglish
Pages (from-to)495-498
Number of pages4
JournalPediatric Infectious Disease Journal
Volume19
Issue number6
DOIs
StatePublished - Jun 2000
Externally publishedYes

Keywords

  • Coagulase-positive staphylococci
  • Gramnegative
  • Holestasis
  • Liver enzymes
  • Neonate
  • Sepsis

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