Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study.

Giannoni, Eric; Agyeman, Philipp K A; Stocker, Martin; Posfay-Barbe, Klara M; Heininger, Ulrich; Spycher, Ben D; Bernhard-Stirnemann, Sara; Niederer-Loher, Anita; Kahlert, Christian R; Donas, Alex; Leone, Antonio; Hasters, Paul; Relly, Christa; Riedel, Thomas; Kuehni, Claudia; Aebi, Christoph; Berger, Christoph; Schlapbach, Luregn J; Sepsis Study, Swiss Pediatric (2018). Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. Journal of pediatrics, 201, 106-114.e4. Elsevier 10.1016/j.jpeds.2018.05.048

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OBJECTIVE To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Agyeman, Philipp; Spycher, Ben; Kühni, Claudia; Aebi, Christoph and Schlapbach, Luregn Jan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0022-3476

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

28 Aug 2018 12:57

Last Modified:

24 Oct 2019 15:32

Publisher DOI:

10.1016/j.jpeds.2018.05.048

PubMed ID:

30054165

Additional Information:

Eric Giannoni and Philipp Agyeman contributed equally to this work

Uncontrolled Keywords:

bacteremia invasive infections meningitis newborn

BORIS DOI:

10.7892/boris.119336

URI:

https://boris.unibe.ch/id/eprint/119336

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