Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Huncikova, Zuzana; Vatne, Anlaug; Stensvold, Hans Jørgen; Lång, Anna; Støen, Ragnhild; Brigtsen, Anne Karin; Salvesen, Bodil; Øymar, Knut; Rønnestad, Arild; Klingenberg, Claus

doi:10.1136/archdischild-2022-324977

Cited by 15 publications

(11 citation statements)

References 41 publications

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“…CoNS, where most isolates came from infants born extremely- or very preterm, was the most frequent causing pathogen in LOS. This is consistent with previous studies [ 10 , 26 , 27 ]. The CFR for CoNS seen in our study was in line with previous studies [ 10 , 33 ].…”

Section: Discussionsupporting

confidence: 94%

“…The incidence of GPB sepsis in this study was 1.47/1000 LB, which is more than 4 times the incidence for GNB sepsis (0.35/1000 LB) in our area, but with a lower SFR (2.8% versus 16.8%) and CFR (9.5% versus 28.0%) [ 14 ]. This result is in line with previous studies showing a higher mortality rate for GNB sepsis compared to GPB sepsis [ 10 , 26 , 27 ]. Few studies have reported on GPB-sepsis separately, but our GPB-SFR in LOS is like that of a recent Norwegian study [ 27 ].…”

Section: Discussionsupporting

confidence: 93%

“…This result is in line with previous studies showing a higher mortality rate for GNB sepsis compared to GPB sepsis [ 10 , 26 , 27 ]. Few studies have reported on GPB-sepsis separately, but our GPB-SFR in LOS is like that of a recent Norwegian study [ 27 ]. In EOS, most affected infants were born full-term and GBS was the most common pathogen, concordant to previous international and Swedish studies [ 1 , 28 – 30 ].…”

Section: Discussionsupporting

confidence: 93%

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A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Oldendorff,

Nordberg,

Giske

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. Methods A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. Results We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. Conclusion GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

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A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Oldendorff,

Nordberg,

Giske

et al. 2024

Eur J Clin Microbiol Infect Dis

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“…This study highlights a concerning rise of Gram-negative IBIs in infants from April 2011 to March 2019 in England, driven primarily by an increase in incidence of late-onset infection in both neonates and infants. Similar increases in late-onset infections have been observed in the USA, The Netherlands and Norway; however, these were largely driven by Gram-positive IBIs or were seen primarily in premature infants 21–23. Prematurity remains one of the main risk factors for early-onset and late-onset IBIs 24 25.…”

Section: Discussionmentioning

confidence: 68%

Incidence of infant Gram-negative invasive bacterial infections in England, 2011–2019: an observational study using population-wide surveillance data

Hallmaier‐Wacker¹,

Andrews²,

Hope³

et al. 2023

Arch Dis Child

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ObjectiveInvasive bacterial infections account for an estimated 15% of infant deaths worldwide. We aimed to estimate the incidence and trends in invasive bacterial infections in infants caused by Gram-negative pathogens in England during 2011–2019.MethodsLaboratory-confirmed invasive bacterial infections in infants (<1 year old) were identified in the UK Health Security Agency national laboratory surveillance data from April 2011 to March 2019. Polymicrobial infections were defined as two or more bacterial species from the same normally sterile sample site. Early-onset infections were defined as <7 days from birth and late-onset as ≥7 days (neonates 7–28 days; infants ≥29 days). Trend analyses were carried out using Poisson (for episodes/incidence) and beta (for proportions) regression.ResultsThe annual incidence of invasive bacterial infections increased by 35.9%, from 189.8 to 258.0 cases per 100 000 live births (p<0.001). Late-onset infections in both neonates and infants increased substantially over the study period (p<0.001), whereas early-onset infections increased slightly (p=0.002).Escherichia coliwas the most common Gram-negative pathogen isolated and accounted for 27.2% of the overall rise in Gram-negative infant disease incidence. Polymicrobial infections almost doubled, increasing from 29.2 to 57.7 per 100 000 live births (p<0.001), and mostly involved two species (81.3%, 1604/1974 episodes).ConclusionsThe incidence of Gram-negative invasive bacterial infections in infants increased between 2011/2012 and 2018/2019 in England, driven mainly by an increase in late-onset infections. Further work is required to elucidate the risk factors and drivers of this increased incidence so that opportunities for prevention can be identified.

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“…In developed countries, it is a rarer cause of late-onset sepsis (LOS) among neonates compared to low- and middle-income countries. Candida prevalence in LOS varies from 1.9% in European countries [20,21] to 5.1% in United States [22 ▪ ] and can be as high as 6.3% in Argentina [26]and 11% in Brazil, with high mortality [25,27 ▪ ,28 ▪ ] (Table 2). It is believed that the higher incidence of Candida spp.…”

Section: Candida Spp Infectionsmentioning

confidence: 99%

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

Fonseca

2024

Current Opinion in Pediatrics

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Purpose of review Invasive fungal infection (IFI) in children is a growing problem with crescent morbidity and mortality, well recognized in developed countries, affecting mainly immunocompromised children, including neonates and children in intensive care units. The burden of IFI in South American children is less well comprehended. In addition, the current epidemiology of endemic systemic mycoses in children may have changed over time. Recent findings Candida spp. infections are very prevalent in South America hospitalized children, especially in neonates, in a rate far superior compared to developed countries. C. auris, has already been responsible for outbreaks in neonates and children in Venezuela and Colombia. Sporotrichosis is well established as an urban zoonosis in impoverish families. Paracoccidioidomycosis and histoplasmosis are affecting new areas of Brazil, probably due to climate change, deforestation, and human migration. Summary This review aims to unveil the real dimension of these infections in South American children. Hopefully, the awareness brought by this review will help healthcare professionals to recognize IFI more easily and it will provide support for getting more resources for IFI treatment and prevention.

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Late-onset sepsis in very preterm infants in Norway in 2009–2018: a population-based study

Cited by 15 publications

References 41 publications

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Incidence of infant Gram-negative invasive bacterial infections in England, 2011–2019: an observational study using population-wide surveillance data

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

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