Bizzarro Matthew J, Dembry Louise-Marie, Baltimore Robert S, Gallagher Patrick G
Division of Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
Infect Control Hosp Epidemiol. 2008 Oct;29(10):914-20. doi: 10.1086/591323.
To compare and contrast the epidemiology of polymicrobial and monomicrobial bloodstream infections (BSIs) in newborn intensive care unit (NICU) patients.
Retrospective, matched case-control study.
The Yale-New Haven Hospital NICU from 1989 through 2006.
NICU patients with BSIs.
Each neonate with polymicrobial BSI (case patient) was matched to one neonate with monomicrobial BSI (control patient), by birth date, weight, and sex; and univariate and multivariate analyses were performed.
One hundred five cases of polymicrobial BSI were identified in 102 infants, representing 10% of all neonatal BSIs in our institution. Coagulase-negative staphylococci were the most common organisms recovered from culture. Infants with polymicrobial BSI had later onset of infection than infants with monomicrobial BSI (mean day of life, 37.5 vs 24.0; P<.001). Polymicrobial BSI occurred more frequently among infants with a severe underlying condition than in those without such a condition (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.2) and among infants requiring an indwelling central venous catheter for a prolonged duration (mean, 16.9 days, compared with 9.8 days for infants with monomicrobial BSI; P=.001). Multivariate analysis revealed that later onset of infection (adjusted OR [aOR], 1.02; 95% CI, 1.00-1.04) and presence of a severe underlying condition (aOR, 1.91; 95% CI, 1.12-3.38) were independent risk factors for polymicrobial BSI. No differences in outcome or mortality were observed.
Changes in the microbiology and epidemiology of NICU-related polymicrobial BSI have occurred since the last North American review. In the present study, although differences were observed, most risk factors and outcomes were similar between monomicrobial BSI and polymicrobial BSI. Epidemiologic surveillance is critical to identify trends associated with neonatal polymicrobial BSI, particularly those that may impact preventative strategies, diagnostic measures, and therapeutic interventions.
比较和对比新生儿重症监护病房（NICU）患者中多微生物血症和单微生物血症（BSIs）的流行病学情况。
回顾性配对病例对照研究。
1989年至2006年期间的耶鲁-纽黑文医院新生儿重症监护病房。
患有血流感染的新生儿重症监护病房患者。
将每例多微生物血流感染的新生儿（病例患者）与1例单微生物血流感染的新生儿（对照患者）按出生日期、体重和性别进行配对；并进行单因素和多因素分析。
在102例婴儿中识别出105例多微生物血流感染病例，占本机构所有新生儿血流感染的10%。凝固酶阴性葡萄球菌是培养中最常见的分离菌。多微生物血流感染的婴儿比单微生物血流感染的婴儿感染发病时间更晚（平均日龄，37.5天对24.0天；P<0.001）。多微生物血流感染在有严重基础疾病的婴儿中比无此类疾病的婴儿更频繁发生（比值比[OR]，1.8；95%置信区间[CI]，1.1 - 3.2），并且在需要长期留置中心静脉导管的婴儿中更常见（平均16.9天，而单微生物血流感染的婴儿为9.8天；P = 0.001）。多因素分析显示，感染发病时间较晚（校正OR[aOR]，1.02；95%CI，1.00 - 1.04）和存在严重基础疾病（aOR，1.91；95%CI，1.12 - 3.38）是多微生物血流感染的独立危险因素。未观察到结局或死亡率的差异。
自上次北美综述以来，与新生儿重症监护病房相关的多微生物血流感染的微生物学和流行病学已发生变化。在本研究中，尽管观察到差异，但单微生物血流感染和多微生物血流感染之间的大多数危险因素和结局相似。流行病学监测对于识别与新生儿多微生物血流感染相关的趋势至关重要，特别是那些可能影响预防策略、诊断措施和治疗干预的趋势。
