Incidence, Clinical Characteristics and Attributable Mortality of Persistent Bloodstream Infection in the Neonatal Intensive Care Unit

Abstract

BackgroundAn atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection.MethodsAll episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period.ResultsWe identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI.ConclusionsAlthough persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes.

Trends, risk factors and outcomes of healthcare-associated infections in a neonatal intensive care unit in Italy during 2013–2017

“…During 2013-2017, Gram-positive bacteria, in particular CONS (25.3%) and S. aureus (2.3%), were the most frequent pathogens responsible for CLABSIs. This finding is in accordance with several reports showing that grampositive bacteria are the main cause of bloodstream infections in neonates in the NICUs [4,12,17,[28][29][30]. Other most frequent pathogens responsible for CLABSIs in the NICU were Candida spp., C. parapsilosis (21.8%) and C. albicans (4.6%), P. aeruginosa (5.7%), E. coli (3.4%) and K. pneumoniae (3.4%).…”

“…This finding is in agreement with previous studies showing that bloodstream infections prevailed among HAIs in Italian NICUs [16,17] and that bloodstream infections were the main infections (45,4%), followed by lower respiratory tract infections (27.8%) and urinary tract infections (15.8%) in Italian and Brazilian PICUs and NICUs [19]. High percentage of bloodstream infections in NICUs has been also reported by NHSN in USA [4], neonINnetwork in UK [12] and worldwide [28][29][30][31]. Finally, the increase of CLABSI incidence density during 2013-2017 in our NICU is alarming because CLABSI rates measure Hospital performance for high-quality patient care [32].…”

“…The elevated number of device-associated infections in the NICU strengthen the importance to calculate device utilization rates and use as risk factors for the development of CLABSIs and VAPs according to NHSN surveillance protocol [3][4][5]. Also, in agreement with previous surveillance studies of HAIs in other NICUs [16,19,29] and in the same NICU during 2006-2010 [18], UTIs were the third most frequent cause of HAIs after CLABSIs and VAPs in our NICU, but decreased from 28.8% [18] to 8.8% during 2013-2017.…”

Earlier and more targeted treatment of neonatal sepsis

“…Sepsis often aggravates other neonatal morbidities, including necrotising enterocolitis, patent ductus arteriosus and bronchopulmonary dysplasia . Long‐term neurological and developmental outcome may be impaired.…”

Epidemiological Features of Nosocomial Bloodstream Infections in Pediatric Patients

“…Yenidoğanlar başta olmak üze-re, pediyatrik hastalarda giderek artan oranda nKDİ ile ilişkili morbidite ve mortalite görülmektedir (2). Dünya genelinde yayımlanan raporlar özellikle Yenidoğan YBÜ'de meydana gelen nozokomiyal infeksiyon oranları için geniş varyasyonlara işaret etmekle birlikte, bu raporlarda söz konusu oranların gelişmekte olan ülkelerde daha yüksek olduğu gözlenmekte-dir (7,8). Nozokomiyal infeksiyon gelişme oranının bebeğin gestasyon yaşı ve vücut ağırlığıyla ters orantılı olduğu bilinmektedir.…”