Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

Didier, Capucine; Streicher, Marie-Pierre; Chognot, Didier; Campagni, Raphaèle; Schnebelen, Albert; Messer, J; Donato, Luigi; Langer, B.; Meyer, Nicolás; Astruc, Dominique; Kuhn, Pierre

doi:10.1007/s00431-011-1639-7

Cited by 65 publications

(53 citation statements)

References 27 publications

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“…25 However, there is a concern that antenatal antibiotic exposure may increase bacterial resistance. 26 However, we did not have access to antibiotic resistance patterns.…”

Section: Discussionmentioning

confidence: 99%

Late-onset Bloodstream Infections in Hospitalized Term Infants

Testoni¹,

Hayashi

Cohen‐Wolkowiez

et al. 2014

Pediatric Infectious Disease Journal

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Background The epidemiology and incidence of late-onset bloodstream infections (BSIs) in premature infants has been described, but studies describing late-onset BSI in term infants are sparse. We sought to describe the pathogens, incidence, risk factors, and mortality of late-onset BSI in hospitalized term infants. Methods A cohort study was conducted of infants ≥37 weeks gestational age and ≤120 days old discharged from Pediatrix Medical Group neonatal intensive care units from 1997–2010. We examined all cultures obtained from day of life (DOL) 4–120 and used multivariable regression to assess risk factors for late-onset BSI. Results We found a total of 206,019 infants cared for between DOL 4 and 120, and the incidence of late-onset BSI was 2.7/1000 admissions. We identified Gram-positive organisms in 64% of the cultures and Gram-negative organisms in 26%. We found a decreased risk of late-onset BSI in infants with the following characteristics: small for gestational age, delivery by Cesarean section, antenatal antibiotic use, and discharged in the later years of the study. Late-onset BSI increased the risk of death after controlling for confounders (odds ratio 8.43 [95% confidence interval 4.42, 16.07]). Conclusion Our data highlight the importance of late-onset BSI in hospitalized term infants. We identified Gram-positive organisms as the most common pathogen, and late-onset BSI was an independent risk factor for death.

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“…25 However, there is a concern that antenatal antibiotic exposure may increase bacterial resistance. 26 However, we did not have access to antibiotic resistance patterns.…”

Section: Discussionmentioning

confidence: 99%

Late-onset Bloodstream Infections in Hospitalized Term Infants

Testoni¹,

Hayashi

Cohen‐Wolkowiez

et al. 2014

Pediatric Infectious Disease Journal

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“…56,57 Staphylococcus aureus is associated with 4–8% 7,58 Staphylococcus commonly colonizes the human skin and mucous membranes and is capable of adhering to plastic surfaces with the subsequent formation of biofilms. These biofilms protect the bacteria from antibiotic penetration and can produce substances that will help them evade the immune system.…”

Section: Late Onset Sepsis (Los)mentioning

confidence: 99%

Neonatal Infectious Diseases

Camacho-González

Spearman

Stoll

2013

Pediatric Clinics of North America

364

143

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Synopsis Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation and early initiation of therapy are required to prevent adverse outcomes. The following chapter reviews recent trends in epidemiology, and provides an update on risk factors, diagnostic methods and management of neonatal sepsis.

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“…2 LOS-related mortality in very LBW newborns ranges from 2% in cases of infection due to coagulase-negative Staphylococci to 30% to 50% in cases of infection caused by aggressive pathogens, such as the KlebsiellaEnterobacter-Serratia group, Pseudomonas, and Candida species. 1,3,4 The occurrence of LOS in extremely LBW newborns significantly impairs their neurodevelopmental outcome at 22 months of life in survivors.…”

mentioning

confidence: 99%

Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns

Poggi,

Bianconi,

Gozzini

et al. 2015

Pediatrics

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BACKGROUND: Late-onset sepsis (LOS) is among the leading causes of morbidity and mortality in preterm newborns, and currently available diagnostic tools are inadequate. The objective of this study was to evaluate the accuracy of presepsin (P-SEP) as novel biomarker of bacterial infection for the diagnosis of LOS in preterm newborns. METHODS:We prospectively studied newborns #32 weeks' gestational age with LOS (n = 19) and noninfected controls (n = 21) at 4 to 60 days' postnatal age. At enrollment, and 1, 3, and 5 days later, we ascertained the C-reactive protein, procalcitonin, and P-SEP in the LOS group, whereas P-SEP alone was ascertained in the control group.RESULTS: P-SEP at enrollment was higher in the LOS than the control group (median 1295 vs 562 ng/L, P = .00001) and remained higher throughout the study period. In the LOS group, P-SEP had a borderline reduction at day 1 versus values at enrollment (median 1011 vs 1295 ng/L, P = .05), whereas C-reactive protein and procalcitonin at day 1 did not differ from baseline values. The receiver operating characteristic curve of P-SEP at enrollment shows an area under the curve of 0.972. The best calculated cutoff value was 885 ng/L, with 94% sensitivity and 100% specificity. Negative likelihood ratio was 0.05, and positive likelihood ratio was infinity. CONCLUSIONS:We demonstrated for the first time in a cohort of preterm newborns that P-SEP is an accurate biomarker for the diagnosis of possible LOS and may also provide useful information for monitoring the response to therapeutic interventions. WHAT'S KNOWN ON THIS SUBJECT:Early diagnosis of LOS in preterm infants may be challenging because of the questionable accuracy of blood culture and the common markers of infections, such as C-reactive protein and procalcitonin. WHAT THIS STUDY ADDS:Our study demonstrated for the first time that P-SEP is an accurate biomarker for the diagnosis of LOS in preterm infants and might contribute to the monitoring of infant response to therapeutic interventions.

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Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

Cited by 65 publications

References 27 publications

Late-onset Bloodstream Infections in Hospitalized Term Infants

Late-onset Bloodstream Infections in Hospitalized Term Infants

Neonatal Infectious Diseases

Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns

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