Background:
We compared the hospital-based epidemiology of neonatal sepsis after the coronavirus disease 2019 lockdown (LD) versus historical epochs and the LD period versus phases of unlocking.
Methods:
This retrospective cohort study was conducted in a level 3 neonatal unit. We compared neonates born in three 24-week periods—Group
LD
: 22 March 2020 to 5 September 2020—the reference group, Group
pre-LD
: 29 September 2019 to 14 March 2020 and Group temporally corresponding to LD in 2019 (
corres-LD
): 24 March 2019 to 7 September 2019. We also studied linear trends from LD phase 1.0 until Unlock 4.0. The key outcome was culture-positive sepsis.
Results:
There were 1622, 2744 and 2700 subjects in groups
LD
,
pre-LD
and
corres-LD
, respectively. The incidence of any culture-positive sepsis in
pre-LD
was higher than
LD
[odds ratio (95% CI) = 1.61 (1.02–2.56)]. This was mainly due to a statistically significant reduction in
Acinetobacter baumannii
sepsis, with incidence rate differences of
pre-LD
versus
LD
[0.67 (95% CI: 0.37–0.97),
P
= 0.0001] and
corres-LD
versus
LD
[0.40 (95% CI: 0.16–0.64),
P
= 0.0024]. Groups
pre-LD
and
corres-LD
had higher proportion of multi-drug resistant (MDR)/extreme drug resistance/pan drug resistance sepsis than
LD
[77%, 77% and 44%, respectively (
P
values of both groups vs.
LD
= 0.01)]. From LD 1.0 to unlock 4.0, there were fewer episodes of MDR sepsis (
P
linear trends
= 0.047). On multivariable analysis, group
pre-LD
(vs. reference group
LD
), male sex, birth weight and Apgar score independently predicted culture-positive sepsis.
Conclusions:
LD favorably impacted the epidemiology of neonatal sepsis in a hospital setting, with less
A. baumannii
and MDR sepsis, which persisted during unlocking.
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