Division of Child Health, St George's, University of London, Cranmer Terrace, Tooting, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F15-8. doi: 10.1136/adc.2009.169540. Epub 2010 Jun 10.
To determine the incidence, mortality and risk factors for neonatal late onset gram-negative sepsis and meningitis (LOGNS).
Retrospective case-control study.
Tertiary neonatal unit in London.
Consecutive inborn infants with late onset (>48 h of life) invasive gram-negative infections diagnosed between 1999 and 2005. Controls were healthy infants matched for gestation and time of admission to the neonatal unit.
Clinical and risk factor data.
73 cases of LOGNS were identified of which 48 were inborn and included in the study (incidence 1.85/1000 live births). Enterobacter spp. (28%), Escherichia coli (27%) and Klebsiella spp. (21%) were the most common pathogens. The majority of infants were of very low birthweight (VLBW; 79%), and cases and controls were well matched (median gestation 26 weeks). Overall case death was 27% in cases versus 13.5% in controls (p=0.08). There was no significant difference between cases and controls regarding maternal risk factors. Mechanical ventilation, total parenteral nutrition (TPN) and its duration, presence of a central venous line and its duration, use of specific antibiotics and the occurrence of necrotising enterocolitis at or before the first positive culture were all significantly associated with case status in univariate analysis. In multivariate logistic regression analysis, only duration of TPN at or before first positive blood culture remained independently associated with LOGNS (p<0.001).
LOGNS occurs predominantly in VLBW infants. When the influence of gestational age is accounted for, the only independent risk factor found for late onset gram-negative neonatal infections is the duration of TPN.
确定新生儿晚发性革兰氏阴性败血症和脑膜炎（LOGNS）的发生率、死亡率和危险因素。
回顾性病例对照研究。
伦敦的一家三级新生儿病房。
1999 年至 2005 年间诊断为晚发性（>48 小时）侵袭性革兰氏阴性感染的连续出生婴儿。对照组为胎龄和入住新生儿病房时间相匹配的健康婴儿。
临床和危险因素数据。
共发现 73 例 LOGNS，其中 48 例为出生时感染病例，纳入本研究（发生率为 1.85/1000 活产儿）。肠杆菌属（28%）、大肠杆菌（27%）和克雷伯菌属（21%）是最常见的病原体。大多数婴儿极低出生体重（VLBW；79%），病例和对照组之间的情况相当匹配（中位胎龄 26 周）。总体病例死亡率为 27%，对照组为 13.5%（p=0.08）。在母亲的危险因素方面，病例组和对照组之间没有显著差异。机械通气、全胃肠外营养（TPN）及其持续时间、中央静脉导管的存在及其持续时间、特定抗生素的使用以及在第一次阳性培养前发生坏死性小肠结肠炎与病例状态在单变量分析中均显著相关。在多变量逻辑回归分析中，只有在第一次血培养阳性前的 TPN 持续时间与 LOGNS 独立相关（p<0.001）。
LOGNS 主要发生在 VLBW 婴儿中。当考虑胎龄的影响时，发现晚发性革兰氏阴性新生儿感染的唯一独立危险因素是 TPN 的持续时间。
