Major articleNeonatal gram-negative bacillary late-onset sepsis: A case-control-control study on a prospectively collected database of 5,233 admissions
Section snippets
Study population and design
This study was conducted in the NICU of Chang Gung Memorial Hospital (CGMH), which provides care from primary to tertiary levels in a university-affiliated teaching hospital in Northern Taiwan. The NICU of the CGMH includes 3 units and has a total capacity of 49 beds equipped with mechanical ventilators and 28 beds with special care nurseries. We made use of the prospectively collected neonatal database of our NICU, which have been kept by research nurses for >10 years.5, 19 Between January
Incidence of gram-negative LOS
During the study period, a total of 5,233 neonates were hospitalized in our NICUs, and a total of 223 neonates, including 181 neonates who died within the first 3 days of life and 42 neonates who were transferred to other hospitals, were excluded from the analysis. Of 5,010 neonates enrolled, 713 (14.2%) neonates had a total of 942 episodes of LOS; of them, 290 (5.8%) neonates had a total of 346 episodes of GNB LOS (36.7% of all LOS). The incidence rate of GNB LOS in the entire cohort was 13.6
Discussion
Results from this study showed that more than one-third of NICU GNB LOS occurred in neonates with a BW of >1,500 g or GA ≥33 weeks, and they accounted for 29.4% (15/51) of all fatal cases; however, VLBW infants or extremely preterm infants were more likely to have GNB LOS than late-preterm or term-born infants. These suggest that not only VLBW infants but also non-VLBW infants encounter GNB LOS and the non-VLBW infant population were ignored previously. The GNB LOS-attributable mortality rate
Conclusions
GNB LOS deserves greater concern because it is associated with a significantly higher severity of illness and sepsis-attributable mortality rate. The risk factor identified in this study, longer duration of total parenteral nutrition, is consistent with risk factors identified by previous investigators. Patients with certain underlying chronic diseases or patients infected with P aeruginosa should be targeted and assessed for higher risk of in-hospital mortality when deciding the treatment
Acknowledgments
We thank Chiao-Ching Chiang for keeping the database of our NICU, and we thank all nursing staff working in our NICUs for keeping extremely detailed patient records, which contributed greatly to the completion of this research. We also thank Chun-Chun Cheng and Yu-Jr Lin for statistical consultation, who was supported by grants from the Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital (grant no. CLRPG340599).
References (40)
- et al.
Recurrent late-onset sepsis in the neonatal intensive care unit: incidence, clinical characteristics and risk factors
Clin Microbiol Infect
(2014) - et al.
Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point prevalence survey
J Pediatr
(2001) - et al.
Predictors of clinical and microbiological treatment failure in neonatal bloodstream infections
Clin Microbiol Infect
(2015) - et al.
Enteric gram-negative bacilli bloodstream infections: 17 years’ experience in a neonatal intensive care unit
Am J Infect Control
(2004) - et al.
Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units
Am J Infect Control
(2007) - et al.
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting
Am J Infect Control
(2008) - et al.
Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance
Clin Microbiol Infect
(2012) - et al.
A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units
Am J Infect Control
(2007) - et al.
Risk-factors for emerging bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli
Clin Microbiol Infect
(2008) - et al.
Consecutive Serratia marcescens multiclone outbreaks in a neonatal intensive care unit
Am J Infect Control
(2012)
Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network
Pediatrics
Is bloodstream infection preventable among premature infants? A tale of two cities
Pediatrics
Determinants of nosocomial infection in 6 neonatal intensive care units: an Italian multicenter prospective cohort study
Infect Control Hosp Epidemiol
Incidence, clinical characteristics, and risk factors for adverse outcome in neonates with late onset sepsis
Pediatr Infect Dis J
Seventy-five years of neonatal sepsis at Yale: 1928-2003
Pediatrics
Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004
Pediatr Infect Dis J
Early and late onset sepsis in late preterm infants
Pediatr Infect Dis J
Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (<=10 mg/L)
BMC Infect Dis
Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit
Pediatr Infect Dis J
Risk factors for late onset gram-negative infections: a case-control study
Arch Dis Child Fetal Neonatal Ed
Cited by (15)
Device-associated infections in neonatal care units in a middle-income country, 2016–2018
2023, Jornal de PediatriaHealthcare-Associated Infections
2023, Avery's Diseases of the NewbornEpidemiology and microbiology of late-onset sepsis among preterm infants in China, 2015–2018: A cohort study
2020, International Journal of Infectious DiseasesCitation Excerpt :Gram-negative bacteria LOS was related with the most significantly increased risk of death, PVL, BPD, and NEC. This is consistent with previous reports that infants with Gram-negative bacteremia have a higher severity of illness (Tsai et al., 2016). No association was found between Gram-positive bacteremia and adverse neonatal outcomes except NEC; however, the study might have been underpowered to detect the association because of the relatively low event rates of adverse outcomes.
Health Care-Associated Infections
2018, Avery's Diseases of the Newborn: Tenth EditionRisk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit
2017, Journal of Hospital InfectionCitation Excerpt :The incidence of nosocomial infections caused by Gram-negative (GN) bacteria has been mounting over recent decades [3]. GN late-onset sepsis (LOS) is often associated with a higher mortality rates than is LOS with Gram-positive (GP) bacteria [4,5]. The emergence of carbapenem-resistant (CR) strains of GN bacteria in neonatal intensive care units (NICUs) has been reported by several surveys [6–8].
Health Care-Associated Infections
2017, Avery's Diseases of the Newborn, Tenth Edition
Conflicts of Interest: None to report.
- 1
Contributed equally to this article.