Epidemiology of Early and Late Onset Neonatal Sepsis in Very Low Birthweight Infants

Abstract

Background: Sepsis is a major cause of death in neonates. Knowledge about epidemiology, risk factors, causative pathogens and outcome of neonatal sepsis is important to improve neonatal care. For Germany, only few data on neonatal sepsis in very low birth weight (VLBW) infants exist. Methods: Data from 14,926 preterm infants with birth weight <1500 g and gestational age between 22 0/7 weeks and 31 6/7 collected between January 2009 and December 2017 were analyzed for frequency of early-onset sepsis (EOS) and late-onset sepsis (LOS) and for causative pathogens. Risk factors for the development of EOS and LOS and outcomes after EOS and LOS were analyzed by multivariate logistic regression models. Results: EOS occurred in 1.1% of infants and LOS in 11.9%. Escherichia coli was the most common pathogen in EOS, coagulase-negative staphylococci in LOS. Multidrug-resistant organisms were detected in 8.4% of EOS and 3.9% of LOS cases. Risk factors for EOS were lower gestational age, intra-amniotic infection and spontaneous delivery. Risk factors for LOS were lower gestational age, small for gestational age, central lines, endotracheal ventilation and history of EOS. Both EOS and LOS were independently associated with adverse neonatal outcome. Conclusions: These data from a large German neonatal cohort confirm neonatal sepsis as the most common cause of morbidity and mortality in VLBW infants, as well as E. coli and coagulase-negative staphylococci as the most prevalent pathogens. Multidisciplinary approaches such as antibiotic stewardship, hygiene and feeding strategies are necessary to further reduce the burden of sepsis in VLBW infants.

Impact of early antibiotic exposure on the risk of colonization with potential pathogens in very preterm infants: a retrospective cohort analysis

“…This is in line with data from Germany and the USA, reporting that more than 80% of VLBWI receive early antibiotics [ 4 , 16 ]. Incidence of sepsis during the first week (EOS and LOS) was low in our cohort (4.8% for infants < 32 weeks) according to data from Germany [ 1 ] and other countries [ 17 , 18 ]). In 28.1% of infants receiving antibiotics in the first postnatal week, therapy was terminated within 48 h, suggesting clinical resolution of symptoms and no increase in inflammation markers.…”

“…Although neonatal sepsis with Enterobacter spp . is comparatively rare [ 1 , 23 ], it has been shown that a high relative abundance of Enterobacter cloacae is associated with NEC [ 24 ]. One limitation of our data is that we do not have information about swab location (anal/rectal or throat) for the screening results analyzed in this study so we cannot provide information on whether certain pathogens prefer certain colonization sites.…”

“…Infections are a major cause of morbidity and mortality in preterm infants [ 1 ]. The latter have an increased vulnerability to infections because of an immaturity of their mucosal barriers and alterations in their immune responses compared to adults [ 2 , 3 ].…”

Use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis among high risk mothers

“…The organisms involved in late onset neonatal sepsis (LONS) is usually acquired from the environment rather than transmitted vertically from mother as seen in cases of early onset neonatal sepsis (EONS). 3 According to National Neonatal-Perinatal Database 2002-2003, 2219 out of 145623 (67%) neonates were found to be having EONS. 4 According to Delhi Neonatal Infection Study collaboration, total sepsis was 14.3% out of which two third cases were EONS.…”

Framework for Considering Abnormal Heart Rate Characteristics and Other Signs of Sepsis in Very Low Birth Weight Infants

“…Late-onset neonatal sepsis continues to cause a great deal of morbidity and mortality for very low birth weight infants (VLBW, <1,500 g BW), and earlier treatment, prior to overt clinical deterioration, could improve outcomes. 1,2 Toward this goal, researchers developed a heart rate characteristics index (HeRO score) to continuously display the risk of clinical deterioration from a sepsis-like illness in the ensuing 24-hour period, compared with the risk for all VLBW infants at all times. [3][4][5][6][7] A high HeRO score reflects the detection of abnormal heart rate patterns that might occur in sepsis: low beat-to-beat variability, increased decelerations relative to accelerations, and low sample entropy of heart rate.…”