From the Division of Neonatology, Children's Hospital of Philadelphia.
Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatr Infect Dis J. 2023 Feb 1;42(2):152-158. doi: 10.1097/INF.0000000000003736. Epub 2022 Nov 2.
Serratia spp. are opportunistic, multidrug resistant, Gram-negative pathogens, previously described among preterm infants in case reports or outbreaks of infection. We describe Serratia late-onset infection (LOI) in very preterm infants in a large, contemporary, nationally representative cohort.
In this secondary analysis of prospectively collected data of preterm infants born 401-1500 grams and/or 22-29 weeks gestational age from 2018 to 2020 at 774 Vermont Oxford Network members, LOI was defined as culture-confirmed blood and/or cerebrospinal fluid infection > 3 days after birth. The primary outcome was incidence of Serratia LOI. Secondary outcomes compared rates of survival and discharge morbidities between infants with Serratia and non-Serratia LOI.
Among 119,565 infants, LOI occurred in 10,687 (8.9%). Serratia was isolated in 279 cases (2.6% of all LOI; 2.3 Serratia infections per 1000 infants). Of 774 hospitals, 161 (21%) reported at least one Serratia LOI; 170 of 271 (63%) cases occurred at hospitals reporting 1 or 2 Serratia infections, and 53 of 271 (20%) occurred at hospitals reporting ≥5 Serratia infections. Serratia LOI was associated with a lower rate of survival to discharge compared with those with non-Serratia LOI (adjusted relative risk 0.88, 95% CI: 0.82-0.95). Among survivors, infants with Serratia LOI had higher rates of tracheostomy, gastrostomy and home oxygen use compared with those with non-Serratia LOI.
The incidence of Serratia LOI was 2.3 infections per 1000 very preterm infants in this cohort. Lower survival and significant morbidity among Serratia LOI survivors highlight the need for recognition and targeted prevention strategies for this opportunistic nosocomial infection.
粘质沙雷氏菌是一种机会性、多重耐药的革兰氏阴性病原体，之前在早产儿的病例报告或感染爆发中有所描述。我们描述了在一个大型的、具有全国代表性的早产儿队列中，迟发性感染（LOI）的沙雷氏菌。
在这项对 2018 年至 2020 年期间，胎龄 22-29 周、出生体重 401-1500 克的 774 名 Vermont Oxford Network 成员早产儿前瞻性收集数据的二次分析中，LOI 被定义为出生后>3 天培养确认的血液和/或脑脊液感染。主要结局是沙雷氏菌 LOI 的发生率。次要结局是比较沙雷氏菌和非沙雷氏菌 LOI 婴儿的存活率和出院发病率。
在 119565 名婴儿中，10687 名（8.9%）发生 LOI。279 例（所有 LOI 的 2.6%；每 1000 名婴儿中有 2.3 例沙雷氏菌感染）分离出粘质沙雷氏菌。在 774 家医院中，有 161 家（21%）报告了至少 1 例沙雷氏菌 LOI；271 例中的 170 例（63%）发生在报告 1 或 2 例沙雷氏菌感染的医院，271 例中的 53 例（20%）发生在报告≥5 例沙雷氏菌感染的医院。与非沙雷氏菌 LOI 相比，沙雷氏菌 LOI 患儿的存活率较低（校正相对风险 0.88，95%CI：0.82-0.95）。在幸存者中，与非沙雷氏菌 LOI 患儿相比，沙雷氏菌 LOI 患儿气管造口术、胃造口术和家庭吸氧使用率较高。
在本队列中，每 1000 名非常早产儿中就有 2.3 例沙雷氏菌 LOI。沙雷氏菌 LOI 幸存者的存活率较低，发病率较高，这突显了需要认识到这一机会性医院感染，并制定有针对性的预防策略。
