Abstract
BackgroundAn atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection.MethodsAll episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period.ResultsWe identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI.ConclusionsAlthough persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes.
Highlights
Neonatal bloodstream infection (BSI) is the most common cause of mortality and morbidity after extremely preterm infants have survived the perinatal complications in the neonatal intensive care unit (NICU) [1,2,3]
We identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%)
No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors
Summary
Neonatal bloodstream infection (BSI) is the most common cause of mortality and morbidity after extremely preterm infants have survived the perinatal complications in the neonatal intensive care unit (NICU) [1,2,3]. Existing evidence suggests that persistent coagulase-negative Staphylococcus (CoNS) bacteremia is remarkable for thrombocytopenia and a substantial proportion of morbidities [11,12]. This atypical pattern of neonatal sepsis characterized by persistent BSI has been related with sequestered focal infection, contaminated indwelling devices, or result of biofilm formation [8,11]. Persistent fungal BSI is often ignored [13,14,15], and we do not know whether effective antibiotics should be modified when the blood culture remains positive with persistent clinical symptoms. An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. Previous studies focused only on coagulate-negative staphylococcus infection
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