Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis

Ming Horng Tsai, Jen Fu Hsu, Shih Ming Chu, Reyin Lien, Hsuan Rong Huang, Ming Chou Chiang, Ren Huei Fu, Chiang Wen Lee, Yhu Chering Huang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

132 Scopus citations

Abstract

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 LOS. 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.

Original languageEnglish
Pages (from-to)e7-e13
JournalPediatric Infectious Disease Journal
Volume33
Issue number1
DOIs
StatePublished - 01 2014

Keywords

  • Bacteremia
  • Bloodstream Infection
  • Late-Onset Sepsis
  • Nosocomial Infection
  • Recurrence

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