Incidence, Clinical Characteristics and Risk Factors for Adverse Outcome in Neonates With Late-onset Sepsis

被引:134
作者
Tsai, Ming-Horng [1 ,2 ,3 ]
Hsu, Jen-Fu [2 ,4 ]
Chu, Shih-Ming [2 ,4 ]
Lien, Reyin [2 ,4 ]
Huang, Hsuan-Rong [2 ,4 ]
Chiang, Ming-Chou [2 ,4 ]
Fu, Ren-Huei [2 ,4 ]
Lee, Chiang-Wen [3 ]
Huang, Yhu-Chering [2 ,5 ]
机构
[1] Chang Gung Mem Hosp, Dept Pediat, Div Neonatol & Pediat Hematol Oncol, Yunlin, Taiwan
[2] Chang Gung Univ, Coll Med, Taoyuan, Taiwan
[3] Chang Gung Univ Sci & Technol, Chiayi, Taiwan
[4] Chang Gung Mem Hosp, Div Pediat Neonatol, Dept Pediat, Taoyuan 333, Taiwan
[5] Chang Gung Mem Hosp, Div Pediat Infect Dis, Dept Pediat, Taoyuan 333, Taiwan
关键词
bloodstream infection; nosocomial infection; bacteremia; late-onset sepsis; recurrence; BIRTH-WEIGHT INFANTS; INTENSIVE-CARE-UNIT; BLOOD-STREAM INFECTION; NOSOCOMIAL INFECTION; RESEARCH NETWORK; NATIONAL-SURVEY; PROSPECTIVE COHORT; PRETERM INFANTS; THERAPY; HEALTH;
D O I
10.1097/INF.0b013e3182a72ee0
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Late-onset sepsis (LOS) is a common complication in the neonatal intensive care unit. We aimed to describe the epidemiology, clinical characteristics and risk factors for adverse outcome in neonates with L OS. Methods: We conducted a cohort study of all neonates with LOS at the neonatal intensive care unit of a Tertiary Taiwan Medical Center from January 2004 through December 2011 and used multivariate logistic regression to identify risk factors for final adverse outcome. Results: Among 5010 neonates over 253,644 neonate-days, 713 (14.2%) experienced a total of 942 episodes of LOS (incidence rate, 3.71 episodes per 1000 neonate-days). Although the rates of LOS were inversely proportional to birth weight and gestational age, the incidence rates were comparable among extremely preterm, late preterm and full term neonates. Fungemia was found to have significantly higher rate of infectious complication (30.8%), persistent bloodstream infection (19.2%) and sepsis attributable mortality (23.1%). The overall mortality rate was 12.6% (90/713), and sepsis attributable mortality rate was 7.2% (68/942 episodes). Independent predictors of in-hospital mortality were Pseudomonas LOS (adjusted odds ratio [OR], 14.31; 95% confidence interval [CI]: 3.87-53.0), fungemia (OR, 5.69; 95% CI: 2.48-13.01), presence of congenital anomalies (OR, 4.12; 95% CI: 1.60-10.60), neuromuscular comorbidities (OR, 3.34; 95% CI: 1.66-6.73) and secondary pulmonary hypertension with/without cor pulmonale (OR, 23.48; 95% CI: 5.96-92.49). Conclusions: LOS predisposes hospitalized neonates to increased risk of mortality or morbidity, especially caused by Pseudomonas aeruginosa or Candida spp. More aggressive treatment strategy is worth consideration in neonates with presumed LOS, particularly those with certain underlying chronic conditions.
引用
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页码:E7 / E13
页数:7
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