Epidemiology and complications of late-onset sepsis: an Italian area-based study

English version

Autoři: Alberto Berardi ^aff001; Francesca Sforza ^aff002; Lorenza Baroni ^aff003; Caterina Spada ^aff002; Simone Ambretti ^aff004; Giacomo Biasucci ^aff005; Serenella Bolognesi ^aff006; Mariagrazia Capretti ^aff007; Edoardo Carretto ^aff008; Matilde Ciccia ^aff009; Marcello Lanari ^aff010; Maria Federica Pedna ^aff011; Vittoria Rizzo ^aff012; Claudia Venturelli ^aff013; Crisoula Tzialla ^aff014; Laura Lucaccioni ^aff001; Maria Letizia Bacchi Reggiani ^aff015
Působiště autorů: Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ^aff001; Medico in formazione, Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio, Modena, Italy ^aff002; Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Arcispedale Santa Maria Nuova, Reggio Emilia, Italy ^aff003; Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy ^aff004; Unità Operativa di Pediatria, Ospedale G da Saliceto, Piacenza, Italy ^aff005; Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi, Rimini, Italy ^aff006; Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy ^aff007; Laboratorio di Microbiologia, Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy ^aff008; Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore, Bologna, Italy ^aff009; Unità Operativa di Pediatria, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy ^aff010; Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena, Italy ^aff011; Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini, Cesena, Italy ^aff012; Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ^aff013; Neonatologia, Patologia Neonatale e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy ^aff014; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi—Università di Bologna, Bologna, Italy ^aff015
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225407

Souhrn

Background

Most studies regarding late-onset sepsis (LOS) address selected populations (i.e., neonates with low birth weight or extremely preterm neonates). Studying all age groups is more suitable to assess the burden of single pathogens and their clinical relevance.

Methods

This is a retrospective regional study involving paediatric departments and NICUs in Emilia-Romagna (Italy). Regional laboratory databases were searched from 2009 to 2012. Records of infants (aged 4 to 90 days) with a positive blood or cerebrospinal fluid (CSF) culture were retrospectively reviewed and analysed according to acquisition mode (whether hospital- or community-acquired).

Results

During the study period, there were 146,682 live births (LBs), with 296 patients experiencing 331 episodes of LOS (incidence rate: 2.3/1000 LBs). Brain lesions upon discharge from the hospital were found in 12.3% (40/296) of cases, with death occurring in 7.1% (23/296; 0.14/1000 LBs). With respect to full-term neonates, extremely preterm or extremely low birth weight neonates had very high risk of LOS and related mortality (> 100- and > 800-fold higher respectively). Hospital-acquired LOS (n = 209) was significantly associated with very low birth weight, extremely preterm birth, pneumonia, mechanical ventilation, and death (p< 0.01). At multivariate logistic regression analysis, catecholamine support (OR = 3.2), central venous line before LOS (OR = 14.9), and meningitis (OR = 44.7) were associated with brain lesions or death in hospital-acquired LOS (area under the ROC curve 0.81, H-L p = 0.41). Commonly identified pathogens included coagulase-negative staphylococci (CoNS n = 71, 21.4%), Escherichia coli (n = 50, 15.1%), Staphylococcus aureus (n = 41, 12.4%) and Enterobacteriaceae (n = 41, 12.4%). Group B streptococcus was the predominant cause of meningitis (16 of 38 cases, 42%). Most pathogens were sensitive to first line antibiotics.

Conclusions

This study provides the first Italian data regarding late-onset sepsis (LOS) in all gestational age groups. Compared to full-term neonates, very high rates of LOS and mortality occurred in neonates with a lower birth weight and gestational age. Group B streptococcus was the leading cause of meningitis. Excluding CoNS, the predominant pathogens were Escherichia coli and Staphylococcus aureus. Neonates with hospital-acquired LOS had a worse outcome. Antibiotic associations, recommended for empirical treatment of hospital- or community-acquired LOS, were adequate.

Klíčová slova:

Bacterial pathogens – Fungal pathogens – Neonates – Blood – Birth weight – Nosocomial infections – Neonatal sepsis – Meningitis

Zdroje

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