From the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Pediatr Infect Dis J. 2021 Apr 1;40(4):359-364. doi: 10.1097/INF.0000000000002987.
The objective of the study was to assess the epidemiology of late-onset (LO) neonatal invasive infections with surveillance covering 43 years, starting from 1975.
Observational epidemiologic, retrospective study including a cohort of infants born in western Sweden in 1997-2017, who had a positive blood and cerebral spinal fluid culture between 3 and 120 days of age. A comparison was made of the incidence between 1997-2007 and 2008-2017. Data on LO infections during 3-27 days of life were assessed from 1975.
A total of 473 cases of LO infections were registered in 437 patients. The incidence increased from 2.0 to 3.1/1000 live births (LB) between 1997-2007 and 2008-2017 (P < 0.001). The increase in incidence was most pronounced among infants born <28 weeks gestation (from 255 to 398/1000 LB, P < 0.001). The most frequent pathogens were Staphylococcus aureus (25%), coagulase-negative staphylococci (17%), and Escherichia coli (13%). Infections due to group B Streptococci rose from 0.16/1000 LB to 0.33 (P = 0.03). During the whole surveillance period from 1975 to 2017, there were 579 cases between 3 and 27 days of life. Although the incidence increased in 2008-2017 to 1.9/1000 LB after first declining in 1997-2007, the case-fatality rate continued to decline from 27/284 (9.5%) between 1975 and 1996 to 6/182 (3.3%) in 2008 and 2017 (P = 0.01).
The incidence of LO neonatal invasive infections increased during the study period (1997-2017), but the case-fatality rate remained lower than in the previous surveillance period (1975-1996). Further surveillance and interventions with focus on prevention is critical to counteract the increasing incidence among high-risk infants.
本研究旨在评估从 1975 年开始的 43 年时间里，对晚期（LO）新生儿侵袭性感染的监测结果。
本研究为观察性、回顾性队列研究，纳入了 1997 年至 2017 年在瑞典西部出生的婴儿，其在出生后 3 至 120 天内血和脑脊液培养阳性。比较了 1997-2007 年和 2008-2017 年的发病率。在生命最初 3-27 天期间的 LO 感染数据来自 1975 年的评估。
在 437 名患者中，共登记了 473 例 LO 感染病例。发病率从 1997-2007 年的 2.0/1000 活产儿增加到 2008-2017 年的 3.1/1000 活产儿（P<0.001）。在出生胎龄<28 周的婴儿中，发病率增加最为显著（从 255/1000 活产儿增加到 398/1000 活产儿，P<0.001）。最常见的病原体是金黄色葡萄球菌（25%）、凝固酶阴性葡萄球菌（17%）和大肠埃希菌（13%）。B 组链球菌引起的感染从 0.16/1000 活产儿增加到 0.33（P=0.03）。在整个监测期（1975 年至 2017 年），有 579 例病例发生在生命最初 3-27 天。尽管发病率在 1997-2007 年首次下降后，在 2008-2017 年增加到 1.9/1000 活产儿，但病死率仍持续下降，从 1975 年至 1996 年的 284 例中的 27 例（9.5%）下降到 2008 年和 2017 年的 182 例中的 6 例（3.3%）（P=0.01）。
在研究期间（1997-2017 年），LO 新生儿侵袭性感染的发病率增加，但病死率仍低于前一个监测期（1975-1996 年）。为了对抗高危婴儿中发病率的上升，需要进一步进行监测和干预，重点关注预防。
