From the Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Department of Neonatology, Suzhou Municipal Hospital, Jiangsu, China.
Pediatr Infect Dis J. 2020 Mar;39(3):232-238. doi: 10.1097/INF.0000000000002558.
Culture-negative late-onset sepsis (LOS) is commonly diagnosed in neonatal intensive care units, while the outcomes of neonatal culture-negative LOS are not reported for large cohorts. This study aimed to examine the incidence and neonatal outcomes for culture-negative LOS in a contemporary multicenter cohort of preterm infants.
We performed a retrospective analysis of data from a cluster-randomized controlled study. Infants <34 weeks of gestation and admitted to 25 neonatal intensive care units between May 1, 2015, and April 30, 2018, were included. Culture-negative LOS was diagnosed if infants had abnormal manifestations and laboratory tests but negative blood cultures. The primary outcome was a composite of mortality or morbidities including periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) ≥ stage 3 or bronchopulmonary dysplasia (BPD).
Of 22,346 eligible infants, 1505 (6.7%) infants had culture-negative and 761 (3.4%) infants had culture-positive LOS. Compared with infants without LOS, infants with culture-negative LOS had higher rates of composite outcome (24.1% vs. 9.6%), death (3.8% vs. 1.8%), PVL (4.8% vs. 2.2%), severe ROP (3.3% vs. 1.1%) and BPD (18.1% vs. 7.0%). After adjustment, culture-negative LOS was independently associated with increased risk of composite outcome {adjusted odds ratio [aOR]: 1.8 [95% confidence interval (CI): 1.5-2.1]}, PVL [aOR: 2.0 (95% CI: 1.4-2.8)] and BPD [aOR: 1.8 (95% CI: 1.5-2.2)] relative to the absence of LOS.
Culture-negative LOS was frequently diagnosed in preterm infants and was associated with increased risks of adverse outcomes. There is an emerging need for more precise diagnosis and treatment strategies for culture-negative LOS.
在新生儿重症监护病房中，常诊断为阴性培养的迟发性败血症（LOS），而对于大量队列的新生儿阴性培养的 LOS 结局尚未报道。本研究旨在检查在一个当代多中心早产儿队列中阴性培养的 LOS 的发生率和新生儿结局。
我们对一项随机对照研究的资料进行了回顾性分析。纳入 2015 年 5 月 1 日至 2018 年 4 月 30 日期间，胎龄<34 周并入住 25 个新生儿重症监护病房的婴儿。如果婴儿出现异常表现和实验室检查但血培养阴性，则诊断为阴性培养的 LOS。主要结局是包括脑室周围白质软化（PVL）、早产儿视网膜病变（ROP）≥3 期或支气管肺发育不良（BPD）在内的死亡率或发病率的复合结局。
在 22346 名合格婴儿中，有 1505 名（6.7%）婴儿患有阴性培养的 LOS，761 名（3.4%）婴儿患有阳性培养的 LOS。与无 LOS 的婴儿相比，患有阴性培养的 LOS 的婴儿复合结局发生率较高（24.1%比 9.6%）、死亡率（3.8%比 1.8%）、PVL（4.8%比 2.2%）、严重 ROP（3.3%比 1.1%）和 BPD（18.1%比 7.0%）。调整后，阴性培养的 LOS 与复合结局的风险增加相关[调整后的优势比（aOR）：1.8（95%置信区间[CI]：1.5-2.1）]、PVL（aOR：2.0（95%CI：1.4-2.8）]和 BPD[aOR：1.8（95%CI：1.5-2.2）]，与无 LOS 相比。
在早产儿中，常诊断为阴性培养的 LOS，与不良结局的风险增加有关。对于阴性培养的 LOS，需要更精确的诊断和治疗策略。
