Epidemic Microclusters of Blood-Culture Proven Sepsis in Very-Low-Birth Weight Infants: Experience of the German Neonatal Network

被引：31

作者：

Haertel, Christoph ^{[1
]}

Faust, Kirstin ^{[1
]}

Avenarius, Stefan ^{[2
]}

Bohnhorst, Bettina ^{[3
]}

Emeis, Michael ^{[4
]}

Gebauer, Corinna ^{[5
]}

Groneck, Peter ^{[6
]}

Heitmann, Friedhelm ^{[7
]}

Hoehn, Thomas ^{[8
]}

Hubert, Mechthild ^{[9
]}

Kribs, Angela ^{[10
]}

Kuester, Helmut ^{[11
]}

Laux, Reinhard ^{[12
]}

Moegel, Michael ^{[13
]}

Mueller, Dirk ^{[14
]}

Olbertz, Dirk ^{[15
]}

Roll, Claudia ^{[16
]}

Siegel, Jens ^{[17
]}

Stein, Anja ^{[18
]}

Vochem, Matthias ^{[19
]}

Weller, Ursula ^{[20
]}

von der Wense, Axel ^{[21
]}

Wieg, Christian ^{[22
]}

Wintgens, Juergen ^{[23
]}

Hemmelmann, Claudia ^{[24
]}

Simon, Arne ^{[25
]}

Herting, Egbert ^{[1
]}

Goepel, Wolfgang ^{[1
]}

机构：

[1] Univ Lubeck, Dept Pediat, Lubeck, Germany

[2] Univ Magdeburg, Dept Pediat, D-39106 Magdeburg, Germany

[3] Med Sch Hanover, Dept Pediat, Hannover, Germany

[4] Vivantes Klinikum Neukolln, Dept Neonatol, Berlin, Germany

[5] Univ Leipzig, Dept Pediat, Leipzig, Germany

[6] Klinikum Leverkusen, Dept Neonatol, Leverkusen, Germany

[7] Klinikum Dortmund, Dept Neonatol, Dortmund, Germany

[8] Univ Dusseldorf, Dept Pediat, D-40225 Dusseldorf, Germany

[9] Klinikum Siegen, Dept Neonatol, Siegen, Germany

[10] Univ Cologne, Dept Pediat, D-50931 Cologne, Germany

[11] Univ Gottingen, Dept Pediat, D-3400 Gottingen, Germany

[12] Asclepios Klin Barmbek, Dept Neonatol, Hamburg, Germany

[13] Univ Dresden, Dept Pediat, Dresden, Germany

[14] Klinikum Kassel, Dept Neonatol, Kassel, Germany

[15] Sudtstadt Klin Rostock, Dept Neonatol, Rostock, Germany

[16] Vest Klin, Dept Neonatol, Datteln, Germany

[17] Krankenhaus Aud Bult, Dept Neonatol, Hanover, NH USA

[18] Univ Essen Gesamthsch, Dept Pediat, Essen, Germany

[19] Olga Hosp, Dept Neonatol, Stuttgart, Germany

[20] Klinikum Bielefeld, Dept Neonatol, Bielefeld, Germany

[21] Altonaer Kinderkrankenhaus, Dept Neonatol, Hamburg, Germany

[22] Klinikum Aschaffenburg, Dept Neonatol, Aschaffenburg, Germany

[23] Stadt Klinikum Rheydt, Dept Neonatol, Monchengladbach, Germany

[24] Univ Lubeck, Inst Biometry & Med Stat, Lubeck, Germany

[25] Saarland Univ Hosp, Dept Pediat Hematol & Oncol, Homburg, Germany

来源：

PLOS ONE | 2012年 / 7卷 / 06期

关键词：

INTENSIVE-CARE-UNIT; GRAM-NEGATIVE BACILLI; LATE-ONSET SEPSIS; STREAM INFECTIONS; SURVEILLANCE SYSTEM; ENTEROBACTER-CLOACAE; PATHOGEN;

D O I：

10.1371/journal.pone.0038304

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Introduction: We evaluated blood culture-proven sepsis episodes occurring in microclusters in very-low-birth-weight infants born in the German Neonatal Network (GNN) during 2009-2010. Methods: Thirty-seven centers participated in GNN; 23 centers enrolled >= 50 VLBW infants in the study period. Data quality was approved by on-site monitoring. Microclusters of sepsis were defined as occurrence of at least two blood-culture proven sepsis events in different patients of one center within 3 months with the same bacterial species. For microcluster analysis, we selected sepsis episodes with typically cross-transmitted bacteria of high clinical significance including gram-negative rods and Enterococcus spp. Results: In our cohort, 12/2110 (0.6%) infants were documented with an early-onset sepsis and 235 late-onset sepsis episodes (>= 72 h of age) occurred in 203/2110 (9.6%) VLBW infants. In 182/235 (77.4%) late-onset sepsis episodes gram-positive bacteria were documented, while coagulase negative staphylococci were found to be the most predominant pathogens (48.5%, 95%CI: 42.01-55.01). Candida spp. and gram-negative bacilli caused 10/235 (4.3%, 95%CI: 1.68% -6.83%) and 43/235 (18.5%) late-onset sepsis episodes, respectively. Eleven microclusters of blood-culture proven sepsis were detected in 7 hospitals involving a total 26 infants. 16/26 cluster patients suffered from Klebsiella spp. sepsis. The median time interval between the first patient's Klebsiella spp. sepsis and cluster cases was 14.1 days (interquartile range: 1-27 days). First patients in the cluster, their linked cases and sporadic sepsis events did not show significant differences in short term outcome parameters. Discussion: Microclusters of infection are an important phenomenon for late-onset sepsis. Most gram-negative cluster infections occur within 30 days after the first patient was diagnosed and Klebsiella spp. play a major role. It is essential to monitor epidemic microclusters of sepsis in surveillance networks to adapt clinical practice, inform policy and further improve quality of care.

引用

页数：5

共 24 条

[1] Is bloodstream infection preventable among premature infants? A tale of two cities [J].