Wu I-Hsyuan, Tsai Ming-Horng, Lai Mei-Yin, Hsu Lee-Fen, Chiang Ming-Chou, Lien Reyin, Fu Ren-Huei, Huang Hsuan-Rong, Chu Shih-Ming, Hsu Jen-Fu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fu-Shin Rd., Kwei-Shan, Taoyuan, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
BMC Infect Dis. 2017 Jul 3;17(1):465. doi: 10.1186/s12879-017-2574-7.
Neonatal bloodstream infection (BSI) is the most important cause of morbidity and mortality in the neonatal intensive care unit (NICU). Although most neonatal BSIs are primary bacteremia, some are associated with a focus of infection. This distinction is not well characterized.
All patients with neonatal late-onset sepsis (LOS) between January 2006 and December 2013 were enrolled. LOS was categorized as a BSI with a concurrent focus of infection if LOS occurred before or within 24 h after the diagnosis of a specific infectious entity, and as "primary bacteremia" if no concurrent focus of infection was identified. Data concerning demographics, hospital course, microbiology, and outcomes were compared via univariate and multivariate analyses.
Of 948 episodes of neonatal LOS, 781 (82.4%) were primary bacteremia, whereas 167 (17.6%) were associated with a known focus of infection, including meningitis (n = 51, 5.4%), ventilator-associated pneumonia (VAP) (n = 36, 3.8%), catheter-related bloodstream infections (n = 57, 6.0%), and necrotizing enterocolitis (NEC) (n = 21, 2.2%). The majority of NEC-associated BSIs were caused by gram-negative bacilli (85.7%). Group B streptococcus accounted for nearly one-third of all meningitis cases (29.4%). Although sepsis-attributable mortality was comparable between primary bacteremia and neonatal BSIs with a focus of infection, neonatal BSIs with meningitis, VAP, and NEC had significantly higher rates of infectious complications. The independent risk factors of sepsis-attributable mortality were infectious complications (Odds ratio [OR] 6.98; 95% confidence interval [CI] 3.64-13.39, P < 0.001); history of one or more than one previous episode(s) of BSI (OR 2.40 and 7.40; 95% CI 1.21-4.74 and 3.70-14.78, P = 0.012 and <0.001, respectively); and underlying secondary pulmonary hypertension in neonates (OR 4.77; 95% CI 1.91-11.96, P = 0.001).
A considerable proportion of neonatal LOS can be associated with known infectious foci in the NICU. The microbiologic etiology of neonatal LOS with a concurrent focus of infection is significantly different from that of primary bacteremia. Neonatal BSIs with concurrent meningitis, VAP, or NEC are significantly more likely to have infectious complications. This association independently leads to sepsis-attributable mortality.
新生儿血流感染（BSI）是新生儿重症监护病房（NICU）发病和死亡的最重要原因。尽管大多数新生儿BSI是原发性菌血症，但有些与感染灶相关。这种区别尚未得到很好的描述。
纳入2006年1月至2013年12月期间所有患有新生儿晚发性败血症（LOS）的患者。如果LOS发生在特定感染性实体诊断之前或之后24小时内，则将LOS分类为伴有并发感染灶的BSI；如果未发现并发感染灶，则分类为“原发性菌血症”。通过单因素和多因素分析比较人口统计学、住院病程、微生物学和结局等数据。
在948例新生儿LOS发作中，781例（82.4%）为原发性菌血症，而167例（17.6%）与已知感染灶相关，包括脑膜炎（n = 51，5.4%）、呼吸机相关性肺炎（VAP）（n = 36，3.8%）、导管相关血流感染（n = 57，6.0%）和坏死性小肠结肠炎（NEC）（n = 21，2.2%）。大多数与NEC相关的BSI由革兰氏阴性杆菌引起（85.7%）。B组链球菌占所有脑膜炎病例的近三分之一（29.4%）。虽然原发性菌血症和伴有感染灶的新生儿BSI的败血症归因死亡率相当，但伴有脑膜炎、VAP和NEC的新生儿BSI的感染并发症发生率明显更高。败血症归因死亡率的独立危险因素是感染并发症（比值比[OR] 6.98；95%置信区间[CI] 3.64 - 13.39，P < 0.001）；既往有一次或多次BSI发作史（OR分别为2.40和7.40；95% CI 1.21 - 4.74和3.70 - 14.78，P = 0.012和<0.001）；以及新生儿潜在的继发性肺动脉高压（OR 4.77；95% CI 1.91 - 11.96，P = 0.001）。
相当一部分新生儿LOS可能与NICU中已知的感染灶相关。伴有并发感染灶的新生儿LOS的微生物病因与原发性菌血症有显著差异。伴有并发脑膜炎、VAP或NEC的新生儿BSI发生感染并发症的可能性明显更高。这种关联独立导致败血症归因死亡率。
