Matthew J Bizzarro1, Veronika Shabanova2, Robert S Baltimore3, Louise-Marie Dembry4, Richard A Ehrenkranz5, Patrick G Gallagher5. 1. Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Electronic address: matthew.bizzarro@yale.edu. 2. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT. 3. Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, CT. 4. Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, CT; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. 5. Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
Abstract
OBJECTIVES: To evaluate data for the period 2004-2013 to identify changes in demographics, pathogens, and outcomes in a single, level IV neonatal intensive care unit. STUDY DESIGN: Sepsis episodes were identified prospectively and additional information obtained retrospectively from infants with sepsis while in the neonatal intensive care unit from 2004 to 2013. Demographics, hospital course, and outcome data were collected and analyzed. Sepsis was categorized as early (≤3 days of life) or late-onset (>3 days of life). RESULTS: Four hundred fifty-two organisms were identified from 410 episodes of sepsis in 340 infants. Ninety percent of cases were late-onset. Rates of early-onset sepsis remained relatively static throughout the study period (0.9 per 1000 live births). For the first time in decades, most (60%) infants with early-onset sepsis were very low birth weight and Escherichia coli (45%) replaced group B streptococcus (36%) as the most common organism associated with early-onset sepsis. Rates of late-onset sepsis, particularly due to coagulase-negative staphylococci, decreased significantly after implementation of several infection-prevention initiatives. Coagulase-negative staphylococci were responsible for 31% of all cases from 2004 to 2009 but accounted for no cases of late-onset sepsis after 2011. CONCLUSIONS: The epidemiology and microbiology of early- and late-onset sepsis continue to change, impacted by targeted infection prevention efforts. We believe the decrease in sepsis indicates that these interventions have been successful, but additional surveillance and strategies based on evolving trends are necessary.
OBJECTIVES: To evaluate data for the period 2004-2013 to identify changes in demographics, pathogens, and outcomes in a single, level IV neonatal intensive care unit. STUDY DESIGN:Sepsis episodes were identified prospectively and additional information obtained retrospectively from infants with sepsis while in the neonatal intensive care unit from 2004 to 2013. Demographics, hospital course, and outcome data were collected and analyzed. Sepsis was categorized as early (≤3 days of life) or late-onset (>3 days of life). RESULTS: Four hundred fifty-two organisms were identified from 410 episodes of sepsis in 340 infants. Ninety percent of cases were late-onset. Rates of early-onset sepsis remained relatively static throughout the study period (0.9 per 1000 live births). For the first time in decades, most (60%) infants with early-onset sepsis were very low birth weight and Escherichia coli (45%) replaced group B streptococcus (36%) as the most common organism associated with early-onset sepsis. Rates of late-onset sepsis, particularly due to coagulase-negative staphylococci, decreased significantly after implementation of several infection-prevention initiatives. Coagulase-negative staphylococci were responsible for 31% of all cases from 2004 to 2009 but accounted for no cases of late-onset sepsis after 2011. CONCLUSIONS: The epidemiology and microbiology of early- and late-onset sepsis continue to change, impacted by targeted infection prevention efforts. We believe the decrease in sepsis indicates that these interventions have been successful, but additional surveillance and strategies based on evolving trends are necessary.
Authors: Barbara J Stoll; Nellie I Hansen; Pablo J Sánchez; Roger G Faix; Brenda B Poindexter; Krisa P Van Meurs; Matthew J Bizzarro; Ronald N Goldberg; Ivan D Frantz; Ellen C Hale; Seetha Shankaran; Kathleen Kennedy; Waldemar A Carlo; Kristi L Watterberg; Edward F Bell; Michele C Walsh; Kurt Schibler; Abbot R Laptook; Andi L Shane; Stephanie J Schrag; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2011-04-25 Impact factor: 7.124
Authors: Joseph Schulman; Rachel Stricof; Timothy P Stevens; Michael Horgan; Kathleen Gase; Ian R Holzman; Robert I Koppel; Suhas Nafday; Kathleen Gibbs; Robert Angert; Aryeh Simmonds; Susan A Furdon; Lisa Saiman Journal: Pediatrics Date: 2011-02-21 Impact factor: 7.124
Authors: S J Schrag; S Zywicki; M M Farley; A L Reingold; L H Harrison; L B Lefkowitz; J L Hadler; R Danila; P R Cieslak; A Schuchat Journal: N Engl J Med Date: 2000-01-06 Impact factor: 91.245
Authors: Hany Aly; Victor Herson; Anne Duncan; Jill Herr; Jean Bender; Kantilal Patel; Ayman A E El-Mohandes Journal: Pediatrics Date: 2005-06 Impact factor: 7.124
Authors: J S Garland; C P Alex; C D Mueller; D Otten; C Shivpuri; M C Harris; M Naples; J Pellegrini; R K Buck; T L McAuliffe; D A Goldmann; D G Maki Journal: Pediatrics Date: 2001-06 Impact factor: 7.124
Authors: Leena B Mithal; Ram Yogev; Hannah L Palac; Daniel Kaminsky; Ilan Gur; Karen K Mestan Journal: Early Hum Dev Date: 2018-01-23 Impact factor: 2.079
Authors: Sarah M Labuda; Vantha Te; Chivorn Var; Navapol Iv Ek; Sosorphea Seang; Alessandra N Bazzano; Richard A Oberhelman Journal: Am J Trop Med Hyg Date: 2019-06 Impact factor: 2.345
Authors: Michael P Sherman; David H Adamkin; Victoria Niklas; Paula Radmacher; Jan Sherman; Fiona Wertheimer; Karel Petrak Journal: J Pediatr Date: 2016-05-31 Impact factor: 4.406
Authors: Michael Sgro; Anna Kobylianskii; Mark H Yudin; Dat Tran; Julia Diamandakos; Jonathan Sgro; Douglas M Campbell Journal: Paediatr Child Health Date: 2018-04-24 Impact factor: 2.253