Neonatal bacteremia. A 4-year prospective study.

During the 4-year period 1978-81, 14,527 neonates were born at Assaf Harofeh Hospital, including 793 (5.5%) premature infants. During the same period, 41 bacteremias were recorded, making an overall incidence rate of 2.8/1,000 live births. Thirty of the 41 bloodstream infections occurred in premature infants (incidence rate 38/1,000) and 11 in full-term infants (incidence rate 0.8/1,000). The overall case fatality rate was 19.5%, and in the premature group it was 26.7%. Aside from prematurity, the most common underlying conditions were respiratory distress syndrome and prolonged rupture of membranes. Premature infants were at much greater risk of becoming bacteremic (relative risk 47) than were full-term infants. The risk increased with a decrease in the weight of the infants. Of 43 pathogens, 31 were gram-negative (72.3%), and 11 were gram-positive (25.4%). The most common of the gram-negative pathogens belonged to the Klebsiella-Enterobacter group--19 of 43 (44.2%). Among the gram-positive pathogens, Enterococcus was most common--4 of 43 (9.3%). No increased incidence of Group B Streptococcus infections was noted. The Klebsiella-Enterobacter group had by far the highest incidence in our hospital, and the bacteremia caused by these pathogens was nosocomial in nature in all but one case.