Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units

Hornik, Christoph P.; Fort, Prem; Clark, Reese H.; Watt, Kevin M.; Benjamin, Daniel K.; Smith, P. Brian; Manzoni, Paolo; Jacqz-Aigrain, Évelyne; Kaguelidou, Florentia; Cohen‐Wolkowiez, Michael

doi:10.1016/s0378-3782(12)70019-1

Cited by 463 publications

(411 citation statements)

References 17 publications

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“…Gram-negative organisms were isolated most frequently in this VLBW cohort with an increased risk of death among infants with EOS (odds ratio [OR] 1.45; 95% CI: 1.21 to 1.73). 13 …”

Section: Bacterial Pathogensmentioning

confidence: 99%

“…Among 12,204 cases of LOS, gram-positive organisms were most frequent. 13 Several studies have noted an increased risk of mortality among infants with LOS compared with those who are uninfected. 13,18,20 Understanding the epidemiology of LOS helps to identify infants with possible infection and also to select appropriate empiric antimicrobial therapy while awaiting culture results.…”

Section: Group B Streptococcimentioning

confidence: 99%

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Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…Gram-negative organisms were isolated most frequently in this VLBW cohort with an increased risk of death among infants with EOS (odds ratio [OR] 1.45; 95% CI: 1.21 to 1.73). 13 …”

Section: Bacterial Pathogensmentioning

confidence: 99%

Section: Group B Streptococcimentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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“…Su incidencia varía entre los distintos países, alcanzando hasta 16/1.000 recién nacidos vivos (RNV) y 20% en los recién nacidos de muy bajo peso de nacimiento [1][2][3] .…”

Section: Introductionunclassified

Estrategias para reducir infecciones, uso de antimicrobianos y sus efectos en una unidad de neonatología

Urzúa

Ferrés

García

et al. 2017

Rev. chil. infectol.

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“…Early diagnosis of neonatal sepsis is important, but clinical signs are neither specific nor uniform [18]. Many markers have been developed for early detection, including cellsurface markers (CD11b, CD64, CD69), chemokines and cytokines (IL-6, IL-8, IL-10), and acute phase reactants (CRP, procalcitonin).…”

Section: Clinical Manifestations Laboratory Examinations and Earlymentioning

confidence: 99%

Retrospective Epidemiological Investigation on Nosocomial Neonatal Sepsis in Shaanxi Province (2008-2010)

Zhang¹,

Zhang²,

Li³

et al. 2016

OJPed

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Objective: This study assessed the incidence, mortality, and pathogens associated with nosocomial neonatal sepsis (NNS) in Shaanxi Province to improve the prevention and control of NNS. Methods: Nine large neonatal departments in Shaanxi Province participated in this retrospective epidemiological investigation of NNS during the period of 2008-2010, using standardized protocol. The incidence, mortality, pathogens, antibiotic sensitivity, clinical characteristics, prognosis, and costs were analyzed. Results: Of 16,642 neonates admitted to neonatal departments in the 9 hospitals during 2008-2010, there were 139 cases of NNS, with incidence of 8.3% and mortality of 20.8%. The predominant pathogens were Gram-negative bacteria, accounting for 67.6% of positive cultures. Gram-positive bacteria accounted for 24.5% and fungal infection accounted for 7.9%. The most common Gram-negative species were Klebsiella pneumonia (22.3%), Escherichia coli (15.1%), and Enterobacter cloacae (8.6%). The dominant Gram-positive species identified were coagulase negative staphylococcal species (CONS) (8.6%), followed by Staphylococcus aureus 263tance, but no meropenem-or-vancomycin-resistant strains were detected. Preterm and full-term infants showed significant difference in clinical manifestations, laboratory findings, mortality, and cost. Conclusion: NNS in the hospitals of Shaanxi Province showed a decreasing trend from 2008 to 2010, but the mortality did not reduce significantly. The predominant bacteria were Gram negative, and pathogens were found to have varying antibiotic resistance. The preterm group had higher mortality and costs than the full-term infants. Therefore, effective measures should be taken to control NNS, especially in preterm infants.

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Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units

Cited by 463 publications

References 17 publications

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Estrategias para reducir infecciones, uso de antimicrobianos y sus efectos en una unidad de neonatología

Retrospective Epidemiological Investigation on Nosocomial Neonatal Sepsis in Shaanxi Province (2008-2010)

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