Tsai Ming-Horng, Wu I Hsyuan, Lee Chiang-Wen, Chu Shih-Ming, Lien Reyin, Huang Hsuan-Rong, Chiang Ming-Chou, Fu Ren-Huei, Hsu Jen-Fu, Huang Yhu-Chering
Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Division of Basic Medical Sciences and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Am J Infect Control. 2016 Feb;44(2):146-53. doi: 10.1016/j.ajic.2015.09.009. Epub 2015 Nov 7.
Gram-negative bacillary (GNB) bloodstream infections account for 20%-30% of neonatal late-onset sepsis (LOS). We aimed to identify the incidence, clinical characteristics, and risk factors for adverse outcomes in neonates with GNB LOS.
All patients with GNB LOS admitted to the neonatal intensive care units (NICUs) of a university-affiliated teaching hospital in Taiwan from January 1, 2004-December 31, 2011, were enrolled. A case-control-control study was performed to evaluate risk factors for acquisition of neonatal GNB LOS.
Of the 5,010 neonates, 290 (5.8%) had a total of 346 episodes of GNB LOS (36.7% of total LOS), with an incidence rate of 13.6 per 10,000 neonate hospital days. The overall mortality rate was 17.6% (51/290), and the sepsis attributable mortality rate was 9.8% (34/346 episodes). After multivariate logistic regression analysis, neonates with prolonged use of total parenteral nutrition (adjusted odds ratio [OR] = 1.53; 95% confidence interval [CI], 1.02-2.29; P = .041) were independently associated with acquisition of GNB LOS. The independent predictors of in-hospital mortality were Pseudomonas aeruginosa etiology (OR = 11.45; 95% CI, 2.83-46.24) and underlying secondary pulmonary hypertension (OR = 18.02; 95% CI, 3.28-98.89), renal disease (OR = 17.16; 95% CI, 2.96-99.38), and neuromuscular comorbidities (OR = 2.72; 95% CI, 1.06-7.00).
Given the higher illness severity and sepsis-attributable mortality rate of neonatal GNB LOS in the NICU, strategies to reduce the incidence need to be addressed urgently.
革兰氏阴性杆菌(GNB)血流感染占新生儿晚发性败血症(LOS)的20%-30%。我们旨在确定GNB LOS新生儿的发病率、临床特征及不良结局的危险因素。
纳入2004年1月1日至2011年12月31日期间入住台湾某大学附属医院新生儿重症监护病房(NICU)的所有GNB LOS患者。进行病例对照研究以评估新生儿GNB LOS获得的危险因素。
在5010例新生儿中,290例(5.8%)共发生346次GNB LOS发作(占总LOS的36.7%),发病率为每10000新生儿住院日13.6例。总体死亡率为17.6%(51/290),败血症归因死亡率为9.8%(34/346次发作)。多因素逻辑回归分析后,长期使用全胃肠外营养的新生儿(调整优势比[OR]=1.53;95%置信区间[CI],1.02-2.29;P=.041)与GNB LOS的获得独立相关。院内死亡的独立预测因素为铜绿假单胞菌病因(OR=11.45;95%CI,2.83-46.24)、潜在的继发性肺动脉高压(OR=18.02;95%CI,3.28-98.89)、肾病(OR=17.16;95%CI,2.96-99.38)和神经肌肉合并症(OR=2.72;95%CI,1.06-7.00)。
鉴于NICU中新生儿GNB LOS的疾病严重程度和败血症归因死亡率较高,迫切需要采取策略降低发病率。