Clinical and Laboratory Findings of Nosocomial Sepsis in Extremely Low Birth Weight Infants According to Causative Organisms.

Kyung-Hee Park,Narae Lee,Shin-Yun Byun,Su-Jung Park,Seong-Hee Jeong,Mun-Hui Jeong,Young-Mi Han,Mi-Hye Bae

doi:10.3390/jcm11010260

Kyung-Hee Park, Narae Lee + Show 6 more

Open Access

https://doi.org/10.3390/jcm11010260

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Abstract

Background: nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants. Methods: a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them. Results: a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group. Conclusions: in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.

Highlights

Nosocomial sepsis is generally defined as a bloodstream infection that presents after the first 72 h of life among infants hospitalized in the neonatal intensive care unit (NICU)
In order to diagnose nosocomial sepsis early and choose the right empirical antibiotics while avoiding broad-spectrum antibiotics or vancomycin, we tried to identify the differences between causative microorganisms, using clinical findings and routine laboratory findings, when sepsis was suspected in extremely low birth weight (ELBW) infants
The perinatal data were collected from the medical charts of the infants and included the parameters of gender, gestational age (GA), and birth weight (BW)

Summary

Introduction

Nosocomial sepsis is generally defined as a bloodstream infection that presents after the first 72 h of life among infants hospitalized in the neonatal intensive care unit (NICU). Extreme prematurity is one of the greatest risk factors for nosocomial sepsis. 65% of ELBW infants are treated for clinical, or proven, neonatal infection during their hospitalization, and the associated mortality is 20–40% [1,2]. There are multiple factors that put extremely low birth weight (ELBW) infants at high risk, such as prolonged hospitalization, central venous catheters and parenteral nutrition, endotracheal intubation and mechanical ventilation, and lack of enteral feeding [3]. Due to the high risk of nosocomial infection and the associated morbidity in ELBW infants, these patients are frequently exposed to broad-spectrum antibiotics [4]

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