Boo N Y, Ang E B K, Ang E L
Universiti Tunku Abdul Rahman, Faculty of Medicine and Health Sciences, Department of Population Medicine, Kuala Lumpur, Malaysia.
Sultanah Bahiyah Hospital, Department of Paediatrics, Ministry of Health, Alor Setar, Kedah, Malaysia.
Malays J Pathol. 2024 Dec;46(3):401-412.
To determine the epidemiology of blood culture-positive late-onset sepsis (LOS, >72 hours of age) in 44 Malaysian neonatal intensive care units (NICUs).
Study Design: Multicentre retrospective observational study using data from the Malaysian National Neonatal Registry.
739486 neonates (birthweight ≥500g, gestation ≥22 weeks) born and admitted in 2015-2020.
LOS developed in 2707 (0.4%) neonates. Median annual incidence (per 100 admissions) was 12.0 (range: 8.1-13.8) in extremely preterm (EPT, gestation <28 weeks), 5.3 (range: 5.0-6.8) in very preterm (VPT, gestation 28-<32 weeks), 0.5 (range: 0.4-0.7) in moderate/late preterm (gestation 32-<37 weeks) and 0.1 in term (gestation ≥37 weeks) neonates. Gram-negative bacteria accounted for 54.7% of pathogens isolated, gram-positive bacteria 39.3%, and fungal and other pathogens 6.0%. The six most common pathogens were coagulase-negative Staphylococcus (18.3%), Klebsiella spp. (18.3%), Staphylococcus aureus (9.9%), Pseudomonas spp. (8.9%), Acinetobacter spp. (7.7%) and Escherichia coli (5.9%). LOS-attributable mortality was 14.3% in EPT, 9.3% in VPT, 8.3% in LPT and 6.2% in term neonates. Multiple logistic regression analysis showed that EPT, small-for-gestation (SGA), conventional mechanical ventilation (CMV), high frequency ventilation (HFV), TPN and use of central venous lines (CVL) were significant independent risk factors associated with LOS in neonates <32 weeks' gestation. The significant independent risk factors associated with mortality in neonates with LOS were SGA, CMV, HFV, gram-negative sepsis, fungal sepsis, and pneumothorax.
Gram-negative bacteria were the commonest pathogens. Decreasing the usage of invasive ventilation, CVL and TPN may reduce the incidence and mortality of LOS, particularly in neonates <32 weeks gestation.
确定马来西亚44家新生儿重症监护病房（NICU）血培养阳性迟发性败血症（LOS，年龄>72小时）的流行病学情况。
研究设计：利用马来西亚国家新生儿登记处的数据进行多中心回顾性观察研究。
2015 - 2020年出生并入住的739486例新生儿（出生体重≥500g，孕周≥22周）。
2707例（0.4%）新生儿发生迟发性败血症。极早产儿（EPT，孕周<28周）的年发病率中位数（每100例入院）为12.0（范围：8.1 - 13.8），极早早产儿（VPT，孕周28 - <32周）为5.3（范围：5.0 - 6.8），中度/晚期早产儿（孕周32 - <37周）为0.5（范围：0.4 - 0.7），足月儿（孕周≥37周）为0.1。分离出的病原体中革兰氏阴性菌占54.7%，革兰氏阳性菌占39.3%，真菌和其他病原体占6.0%。六种最常见的病原体为凝固酶阴性葡萄球菌（18.3%）、克雷伯菌属（18.3%）、金黄色葡萄球菌（9.9%）、假单胞菌属（8.9%）、不动杆菌属（7.7%）和大肠埃希菌（5.9%）。极早产儿中迟发性败血症所致死亡率为14.3%，极早早产儿为9.3%，晚期早产儿为8.3%，足月儿为6.2%。多因素logistic回归分析显示，极早产儿、小于胎龄儿（SGA）、传统机械通气（CMV）、高频通气（HFV）、全胃肠外营养（TPN）和中心静脉置管（CVL）的使用是孕周<32周新生儿迟发性败血症的显著独立危险因素。迟发性败血症新生儿死亡的显著独立危险因素为小于胎龄儿、传统机械通气、高频通气、革兰氏阴性菌败血症、真菌败血症和气胸。
革兰氏阴性菌是最常见的病原体。减少有创通气、中心静脉置管和全胃肠外营养的使用可能会降低迟发性败血症的发病率和死亡率，尤其是孕周<32周的新生儿。
