Distribution of Late-Onset Neonatal Sepsis Pathogens Differs in Inpatient and Outpatient Settings

Abstract

Objective We sought to examine pathogen distribution and clinical presentation of late-onset sepsis (LOS) at an urban tertiary care center.

Study Design We performed a retrospective review of all culture-confirmed cases of LOS presenting to our institution from 2013 to 2017. Medical records were evaluated for demographic information, sepsis risk factors, encounter location, and clinical outcome.

Results We identified 97 cases of LOS, with a median age at diagnosis of 25 days. The most common pathogens were Escherichia coli (22.7%), Staphylococcus aureus (17.5%), coagulase-negative staphylococci (12.4%), and Enterococcus faecalis (12.4%). Infections due to E. coli predominated in the outpatient setting (44%), whereas S. aureus and Gram-negative organisms other than E. coli were more frequently isolated from inpatients (21 and 24%, respectively). Gram-positive organisms were more common in infants delivered through cesarean section (p = 0.002) and were associated with more complications (p = 0.03). Escherichia coli LOS presented at an earlier age than S. aureus (15 vs. 32 days; p = 0.04). Of the 15 cases of meningitis, 40% did not have a positive blood culture.

Conclusion Pathogen distribution in our population was different from those previously reported, with a higher prevalence of S. aureus. Encounter location and age at presentation varied significantly by pathogen.

Keywords

late-onset sepsis - pathogen - sepsis

• References

• 1 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100 (03) F257-F263
• 2 Vergnano S, Menson E, Kennea N. , et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011; 96 (01) F9-F14
• 3 Morioka I, Morikawa S, Miwa A. , et al. Culture-proven neonatal sepsis in Japanese neonatal care units in 2006-2008. Neonatology 2012; 102 (01) 75-80
• 4 Greenberg RG, Kandefer S, Do BT. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Late-onset sepsis in extremely premature infants: 2000-2011. Pediatr Infect Dis J 2017; 36 (08) 774-779
• 5 Stoll BJ, Hansen N, Fanaroff AA. , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-291
• 6 Stoll BJ, Hansen NI, Adams-Chapman I. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292 (19) 2357-2365
• 7 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 8 Tsai MH, Hsu JF, Chu SM. , et al. Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J 2014; 33 (01) e7-e13
• 9 Testoni D, Hayashi M, Cohen-Wolkowiez M. , et al. Late-onset bloodstream infections in hospitalized term infants. Pediatr Infect Dis J 2014; 33 (09) 920-923
• 10 Sharma P, Kaur P, Aggarwal A. Staphylococcus aureus- the predominant pathogen in the neonatal ICU of a tertiary care hospital in Amritsar, India. J Clin Diagn Res 2013; 7 (01) 66-69
• 11 Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr 2001; 68 (08) 715-717
• 12 Schrag SJ, Farley MM, Petit S. , et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138 (06) e20162013
• 13 Nagai K, Gotoh K, Hirotaki S. , et al. A case of bacterial meningitis due to Streptococcus bovis in an infant with normal cerebrospinal fluid findings at the first CSF examination . [in Japanese ]. Kansenshogaku Zasshi 2008; 82 (01) 26-29
• 14 Murillo JL, Titelbaum JA, Martinez J. Infant with Streptococcus bovis meningitis. J Med Soc N J 1981; 78 (09) 598-599
• 15 Cheung M, Pelot M, Nadarajah R, Kohl S. Neonate with late onset Streptococcus bovis meningitis: case report and review of the literature. Pediatr Infect Dis J 2000; 19 (09) 891-893
• 16 Olivier F, Bertelle V, Shah PS, Drolet C, Piedboeuf B. Association between birth route and late-onset sepsis in very preterm neonates. J Perinatol 2016; 36 (12) 1083-1087
• 17 Dominguez-Bello MG, Costello EK, Contreras M. , et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A 2010; 107 (26) 11971-11975
• 18 Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005; 116 (03) 595-602