Background: Neonatal sepsis is a cause of mortality and long-term morbidity worldwide.
Objectives: To describe longitudinal trends in the cumulative incidence of early- and late-onset sepsis (EOS and LOS), mortality, and causative organisms in a Thai Hospital before and after construction of a new neonatal intensive care unit (NICU).
Methods: Review of NICU admissions with blood cultures positive for bacteria or fungi for the periods 1995 to 2002 (preconstruction) and 2004 to 2010 (postconstruction). Sepsis was categorized into EOS (within first 3 days of life) and LOS (after first 3 days of life).
Results: Of 5,570 admissions, 241 (4.3%) neonates with 276 episodes of sepsis were identified. There was no difference in the rate of sepsis overall (P = 0.90), LOS (P = 0.30), or sepsis-related mortality (P = 0.61) over the two periods, but the rate of EOS increased significantly from 0.34% to 0.81% (P = 0.04). Rates of Klebsiella species and Escherichia coli sepsis increased from 13.6% to 25.6% (P = 0.01) and from 5.3% to 12.2% (P = 0.04), respectively, while rates of Staphylococcus aureus sepsis decreased from 12.9% to 4.3% (P < 0.007). Sepsisrelated mortality was 1.8%.
Conclusions: Although direct causality cannot be proven, the rate of EOS and the pattern of causative organisms changed following construction of the new NICU. Building a new unit does not necessarily result in a reduction in the rate of sepsis. This data may provide a baseline for implementing evidence-based infection control strategies to prevent/reduce sepsis and improve neonatal care.
1. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet. 2010; 375: 1988-2008.
2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095-128.
3. Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA, editors. Infectious diseases of the fetus and new born infant. 7th ed. Philadelphia: Elsevier Saunders; 2011. p. 222-75.
4. Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics. 2005; 116:595-602.
5. Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am. 2013; 60:367-89.
6. Morioka I, Morikawa S, Miwa A, Minami H, Yoshii K, Kugo M, et al. Culture-proven neonatal sepsis in Japanese neonatal care units in 2006-2008. Neonatology. 2012; 102:75-80.
7. Polin RA, Denson S, Brady MT; Committee on Fetus and Newborn; Committee on Infectious Diseases. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics. 2012; 129:e1104-9.
8. Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012; 379:445-52.
9. Mukhopadhyay S, Puopolo KM. Risk assessment in neonatal early onset sepsis. Semin Perinatol. 2012; 36: 408-15.
10. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126:443-56.
11. Al-Taiar A, Hammoud MS, Cuiqing L, Lee JK, Lui KM, Nakwan N, et al. Neonatal infections in China, Malaysia, Hong Kong and Thailand. Arch Dis Child Fetal Neonatal Ed. 2013; 98:F249-55.
12. Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, et al. Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed. 2009; 94: F144-8.
13. Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010; 59:1-36.
14. Boghossian NS, Page GP, Bell EF, Stoll BJ, Murray JC, Cotten CM, et al. Late-onset sepsis in very low birth weight infants from singleton and multiplegestation births. J Pediatr. 2013; 162:1120-4.e1.
15. Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011; 127:817-26.
16. Osrin D, Vergnano S, Costello A. Serious bacterial infections in newborn infants in developing countries. Curr Opin Infect Dis. 2004; 17:217-24.
17. Janjindamai W, Srithaveesinsup Y, Chanwitan P. Neonatal septicemia in Songklanagarind Hospital. Songkla Med J. 1998; 16:9-18.
18. Jiang JH, Chiu NC, Huang FY, Kao HA, Hsu CH, Hung HY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect. 2004; 37:301-6.
19. Wu JH, Chen CY, Tsao PN, Hsieh WS, Chou HC. Neonatal sepsis: a 6-year analysis in a neonatal care unit in Taiwan. Pediatr Neonatol. 2009; 50:88-95.
20. Gill CJ, Mantaring JB, Macleod WB, Mendoza M, Mendoza S, Huskins WC, et al. Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines. Clin Infect Dis. 2009; 48:13-21.
21. Ogunlesi TA, Ogunfowora OB, Osinupebi O, Olanrewaju DM. Changing trends in newborn sepsis in Sagamu, Nigeria: bacterial aetiology, risk factors and antibiotic susceptibility. J Paediatr Child Health. 2011; 47:5-11.
22. van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2010; 97:22-8.
23. Shim GH, Kim SD, Kim HS, Kim ES, Lee HJ, Lee JA, et al. Trends in epidemiology of neonatal sepsis in a tertiary center in Korea: a 26-year longitudinal analysis, 1980-2005. J Korean Med Sci. 2011; 26:284-9.
24. Viswanathan R, Singh AK, Mukherjee S, Mukherjee R, Das P, Basu S. Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India: a 3 year study. Indian J Pediatr. 2011; 78:409-12.
25. Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed. 2005; 90:F220-4.
26. Hocevar SN, Edwards JR, Horan TC, Morrell GC, Iwamoto M, Lessa FC. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol. 2012; 33:1200-6.
27. Larson EL, Cimiotti JP, Haas J, Nesin M, Allen A, Della-Latta P, et al. Gram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units. Pediatr Crit Care Med. 2005; 6:457-61.
28. Parm U, Metsvaht T, Sepp E, Ilmoja ML, Pisarev H, Pauskar M, et al. Risk factors associated with gut and nasopharyngeal colonization by common Gramnegative species and yeasts in neonatal intensive care units patients. Early Hum Dev. 2011; 87:391-9.
29. Jean-Baptiste N, Benjamin DK, Jr., Cohen-Wolkowiez M, Fowler VG, Jr., Laughon M, Clark RH, et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2011; 32:679-86.
30. Thylefors JD, Harbarth S, Pittet D. Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality? Infect Control Hosp Epidemiol. 1998; 19:581-9.