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http://dx.doi.org/10.3345/kjp.2010.53.4.495

Analysis of neonatal sepsis in one neonatal intensive care unit for 6 years  

Chun, Peter (Department of Pediatrics, School of Medicine, Pusan National University)
Kong, Seom-Gim (Department of Pediatrics, School of Medicine, Pusan National University)
Byun, Shin-Yun (Department of Pediatrics, School of Medicine, Pusan National University)
Park, Su-Eun (Department of Pediatrics, School of Medicine, Pusan National University)
Lee, Hyung-Du (Department of Pediatrics, School of Medicine, Pusan National University)
Publication Information
Clinical and Experimental Pediatrics / v.53, no.4, 2010 , pp. 495-502 More about this Journal
Abstract
Purpose : Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm. The objective of this study was to analyze the incidence rate, causative pathogens and clinical features of neonatal sepsis in one neonatal intensive care unit (NICU) for 6 years. Methods : This study was retrospectively performed to review the clinical and laboratory characteristics including sex, gestational age, birth weight, Apgar score, length of hospitalization, length of total parenteral nutrition, presence of central venous catheter, underlying diseases, laboratory findings, microorganisms isolated from blood culture, complications and mortality in 175 patients between January 2003 and December 2008. Results : 1) Sepsis was present in 175 of 3,747 infants for 6 years. There were more gram-positive organisms. 2) The gram-negatives were more prevalent in preterm. There were no significant differences of other clinical features between two groups. 3) Underlying diseases were found in 73.7%, and the most common disease was cardiovascular disease. The most common organisms of gram-positives and gram-negatives were methicillin resistant Staphylococcus aureus (MRSA) and Serratia marcescens. 4) There was statistically significant difference on platelet counts between two groups (P<0.05). 5) Complications were found in 18.3% and septic shock was the most common. MRSA was the most common pathogen in sepsis with complication. 6) The mortality rate was 7.4%. 7) There were differences in monthly blood stream infection/1,000 patient-days. Conclusion : The studies about the factors that can influence neonatal sepsis will contribute to decrease the infection rates in NICUs.
Keywords
Infant; Newborn; Sepsis; Gram-Positive bacteria; Gram-Negative bacteria;
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1 Mullet MD, Cook EF, Gallagher R. Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 1998;18:112-5.
2 Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004;51:939-59.   DOI   ScienceOn
3 Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357-65.   DOI   ScienceOn
4 Hemming VG, Overall JC, Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med 1976;294:1310-6.   DOI   ScienceOn
5 Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA. Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population. Is there an epidemic? JAMA 1987;258:2548-52.   DOI   ScienceOn
6 Kim YS, Kim JK, Yoo HS, Ahn SY, Seo HJ, Choi SH, et al. Pathogens and prognotic factors for early onset sepsis in very low birth weight infants. J Korean Soc Neonatol 2009;16: 163-71.
7 Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, et al. Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr Infect Dis J 2005;24:817-22.   DOI   ScienceOn
8 Bhutta ZA, Yusuf K. Neonatal sepsis in Karachi: factors determining outcome and mortality. J Trop Pediatr 1997;43 :65-70.   DOI   ScienceOn
9 Benitz WE, Gould JB, Druzin ML. Risk factors for earlyonset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 1999;103:e77.   DOI   ScienceOn
10 Storm W. Use of thrombocytopenia for the early identification of sepsis in critically ill newborns. Acta Paediatr Acad Sci Hung 1982;23:349-55.
11 Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: Is there an organism-specific response? Pediatrics 2003;111: 1411-5.   DOI   ScienceOn
12 Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR, et al. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Infect Dis J 1998;17:593-8.   DOI   ScienceOn
13 Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in highrisk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1996;98:357-61.
14 Yoon HJ, Choi JY, Park YS, Kim CO, Kim JM, Yong DE, et al. Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective. Am J Infect Control 2005;33:595-601.   DOI   ScienceOn
15 Kwon HJ, Kim SY, Cho CY, Choi YY, Shin JH, Suh SP. Nosocomial infection in neonatal intensive care unit. J Korean Pediatr Soc 2002;45:719-26.
16 Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr 2008;75:261-6.   DOI   ScienceOn
17 Kliegman RM, Behrman RE, Jenson HB, Stanton BF, Nelson WE. Infections of the neonatal infant. In: Stoll BJ, editor. Nelson textbook of pediatrics. 18rd ed. Philadelphia: WB Saunders, 2007:794-811.
18 Sung MJ, Chang CH, Yoon YK, Park SE. Clinical aspects of an outbreak of Serratia marcescens infections in neonates. Korean J Pediatr 2006;49:500-6.   DOI
19 Klein JO. Current antibacterial therapy for neonatal sepsis and meningitis. Pediatr Infect Dis J 1990;9:783-4.   DOI   ScienceOn
20 Trotman H, Bell Y. Neonatal sepsis in very low birthweight infants at the University Hospital of the West indies. West Indian Med J 2006;55:165-9.
21 Tseng YC, Chiu YC, Wang JH, Lin HC, Lin HC, Su BH, et al. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review. J Microbiol Immunol Infect 2002;35:168-72.
22 Moore DL. Nosocomial infection in newborn nurseries and neonatal intensive care units. In: Mayhall CG, editor. Hospital epidemiology and infection control. Baltimore: Williams-Wilkins, 1996;535-64.
23 Stoll BJ, Hansen N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol 2003;27:293-301.   DOI   ScienceOn
24 Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 2006;91:F208-12.
25 Hoogkamp-Korstanje JA, Cats B, Senders RC, van Ertbruggen I. Analysis of bacterial infections in a neonatal intensive care unit. J Hosp Infect 1982;3:275-84.   DOI   ScienceOn
26 Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gramnegative infections continues in the Notional Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J 2005;24:635-9.   DOI   ScienceOn
27 Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:72-80.   DOI   ScienceOn
28 Park HW, Lim G, Koo SE, Lee BS, Kim KS, Pi SY, et al. Causative agents and antimicrobial sensitivity of neonatal sepsis: Ten-year experience in one neonatal intensive care unit. J Korean Soc Neonatol 2009;16:172-81.
29 Gray JE, Richardson DK, McCormick MC, Goldmann DA. Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatrics 1995;95:225-30.
30 Kim BI, Chung HL, Kim YD, Park WS, Shin SM, Lee HJ, et al. Clinical observations on neonatal sepsis. J Korean Pediatr Soc 1987;30:130-7.
31 Lee WS, Cho JY, Yoo ST, Lee CW, Choi DY, Kim JD et al. Platelet count and mean platelet volume in low birth weight infants ($\leq$ 2,000 g) with sepsis. Korean J Pediatr 2007;50: 643-8.   DOI   ScienceOn
32 Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child health and Human Development Neonatal Reserch Network. J Pediatr 1996;129:63-71.   DOI   ScienceOn
33 Polin RA. The "ins and outs" of neonatal sepsis. J Pediatr 2003;143:3-4.   DOI   ScienceOn
34 Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347:240-7.   DOI   ScienceOn
35 Sheu JR, Hung WC, Wu CH. Reduction in lipopolysaccharide- induced thrombocytopenia by triflavin in a rat model of septicemia. Circulation 1999;99:3056-62.   DOI   ScienceOn
36 Kilani RA, Basamad M. Pattern of proven bacterial sepsis in a neonatal intensive care unit in Riyadh Saudi Arabia: a 2- year analysis. J Med Liban 2000;48:77-83.
37 Goldmann DA, Durbin WA, Freeman J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144: 449-59.   DOI   ScienceOn
38 Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy- five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005;116:595-602.   DOI   ScienceOn