Matched Case-Control Analysis of Polymicrobial Bloodstream Infection In A Neonatal Intensive Care Unit

Abstract

Changes in the microbiology and epidemiology of NICU-related polymicrobial BSI have occurred since the last North American review. In the present study, although differences were observed, most risk factors and outcomes were similar between monomicrobial BSI and polymicrobial BSI. Epidemiologic surveillance is critical to identify trends associated with neonatal polymicrobial BSI, particularly those that may impact preventative strategies, diagnostic measures, and therapeutic interventions.

Proteomics Mapping of Cord Blood Identifies Haptoglobin “Switch-On” Pattern as Biomarker of Early-Onset Neonatal Sepsis in Preterm Newborns

“…Each hour of delayed treatment worsens morbidity and mortality [39]. Forty-eight to 72 hours may pass until bacterial growth can be confirmed.…”

“…Because even a 4-hour delay in initiation of antibiotics may increase neonatal mortality related to sepsis, universal “empirical antibiotic therapy” is advocated based on maternal risk factors and clinical suspicion of EONS [40], [41]. In most circumstances antibiotics are discontinued, if microbial culture results are negative, and neonatal clinical symptoms of sepsis absent [39]–[41]. In addition to the considerable financial burden, [42] there are significant downsides to this non-discriminatory therapeutic approach such as frequent monitoring of antibiotic blood levels, renal and oto-toxicity, increase risk of necrotizing enterocolitis (NEC) and changing the diversity of microbes in NBSCUs [39], [43], [44].…”

“…In most circumstances antibiotics are discontinued, if microbial culture results are negative, and neonatal clinical symptoms of sepsis absent [39]–[41]. In addition to the considerable financial burden, [42] there are significant downsides to this non-discriminatory therapeutic approach such as frequent monitoring of antibiotic blood levels, renal and oto-toxicity, increase risk of necrotizing enterocolitis (NEC) and changing the diversity of microbes in NBSCUs [39], [43], [44]. As a result, in the present state of clinical practice, hematological indices are the only laboratory aids available to the neonatologist with respect to clinical decisions to be made shortly after birth (i.e admission to NBSCU, intravenous antibiotic treatment and allocation of necessary resources) [13].…”

Polymicrobial Bloodstream Infection in Neonates: Microbiology, Clinical Characteristics, and Risk Factors

“…The prevalence of PBSI is reported to be around 5% to 27% of all bloodstream infections in adult or pediatric intensive care unit [1], [2], [4]–[8], and is found to be associated with a higher attributable mortality rate than monomicrobial BSIs [3], [9]–[11]. Appropriate treatment of PBSI are often more difficult since the identification of more than one bacterium usually takes more time [1], [11].…”

“…Appropriate treatment of PBSI are often more difficult since the identification of more than one bacterium usually takes more time [1], [11]. Several studies were conducted to address the issue, including which patients were at risk for PBSIs and special consideration should be given when initiating empirical antibiotics, but the results were inconsistent [1], [2], [12], [13].…”