Recurrent late-onset sepsis in the neonatal intensive care unit: incidence, clinical characteristics and risk factors

• Published in: Clinical microbiology and infection Vol. 20; no. 11; pp. O928 - O935
• Main Authors: Tsai, M.-H., Chu, S.-M., Lee, C.-W., Hsu, J.-F., Huang, H.-R., Chiang, M.-C., Fu, R.-H., Lien, R., Huang, Y.-C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2014; Elsevier Limited
• Subjects: Antibiotic resistance; bacteraemia; Case-Control Studies; Female; Hospitals, Teaching; Humans; Incidence; Infant, Newborn; Intensive Care, Neonatal; late-onset sepsis; Male; Recurrence; risk factor; Risk Factors; Sepsis - epidemiology; Sepsis - mortality; Sepsis - pathology; Survival Analysis; Taiwan; Tertiary Care Centers; Treatment Outcome; Taiwan; recurrence; risk factor; late-onset sepsis; Antibiotic resistance; bacteraemia
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/1469-0691.12661

We aimed to characterize the incidence, clinical features, risk factors and outcomes of recurrent late-onset sepsis (LOS) in the neonatal intensive care unit (NICU). All neonates with LOS from the NICU of a tertiary-level teaching hospital in northern Taiwan between 2004 and 2011 were enrolled for analyses. A case-control study was performed to determine risk factors for recurrence. Of 713 neonates with LOS, 150 (21.0%) experienced recurrence and 48 (6.7%) had >1 recurrences; c. two-thirds of recurrent LOS occurred in infants with birth weight (BW) ≦ 1500 g or gestational age (GA) ≦ 30 weeks. The recurrent LOS episodes were significantly more severe and had a higher sepsis-attributable mortality rate than the first episodes. The overall in-hospital mortality rate was 30.7% for neonates with recurrent LOS and 7.8% for those with single LOS (odds ratio (OR), 5.22; 95% CI, 3.28–8.30). When both BW and GA were controlled, neonates with recurrent LOS had a significantly prolonged hospitalization compared with the controls (median 109 vs. 84 days, p <0.001). After multivariate logistic regression, longer duration of total parenteral nutrition (TPN; OR, 1.30; 95% CI, 1.10–1.52 for every 10-day increment), presence of congenital anomalies (OR, 2.64; 95% CI, 1.10–6.35) and neurological co-morbidities (OR, 4.14; 95% CI, 1.14–15.10) were identified as the independent risk factors for LOS recurrence. We concluded that c. one-fifth of neonates with LOS had recurrence, which significantly resulted in prolonged hospitalization and increased mortality. Longer TPN administration, presence of congenital anomalies and neurological co-morbidities are independently associated with recurrent LOS.