PEDIATRICS Vol. 109 No. 1 January 2002, pp. 34-39
Epidemiological, Clinical, and Microbiological Characteristics of Late-Onset Sepsis Among Very Low Birth Weight Infants in Israel: A National Survey
* Department of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
Department of Health Services Research Unit, Ministry of Health, Gertner Institute, Tel-Hashomer, Israel
.
--> Objective. Nosocomial infections are a serious problem among very low birth weight (VLBW) infants. We studied the association between late-onset sepsis (LOS) and mortality and morbidity in VLBW infants.
Methods. From a national cohort of 5555 VLBW infants born in Israel during 1995 through 1998, 4829 survived at least 3 days and composed the study population. Maternal, perinatal, or postnatal variables that showed a significant association with LOS in a univariate analysis were tested in a bivariate analysis (adjusted for gestational age). Variables with P 
.1 were then tested by a multiple logistic regression for assessing the net effect of each variable on the risk for LOS.
Results. One or more episodes of bloodstream-proven LOS occurred in 1453 infants (30%). Gram-positive and Gram-negative bacteria accounted for 55.4% and 31.2% of microbes, respectively, mainly coagulase-negative Staphylococci and Klebsiella. Compared with those without LOS, infants with LOS had a significantly higher mortality rate (16.9% vs 8.6%). Mortality after Gram-negative LOS (26.2%) and Candida LOS (27.6%) was similar and significantly higher than with Gram-positive LOS (8.7%). Significant independent predictors of LOS were decreasing gestational age, cesarean section, mechanical ventilation, patent ductus arteriosus, necrotizing enterocolitis, and bronchopulmonary dysplasia.
Conclusions. LOS occurred in 30% of Israeli VLBW infants. Six strong independent predictors for LOS were identified. Recognition and awareness of the epidemiologic, clinical, and microbiologic characteristics of LOS remain the keystones for management of this nosocomial infection.
Key Words: sepsis • premature infant • very low birth weight infant • morbidity • mortality
Abbreviations: LOS, late-onset sepsis • VLBW, very low birth weight • SCN, Staphylococcus-coagulase-negative • RDS, respiratory distress syndrome • PDA, patent ductus arteriosus • IVH, intraventricular hemorrhage • NEC, necrotizing enterocolitis • BPD, bronchopulmonary dysplasia • GA, gestational age
Received for publication May 2, 2001; Accepted Aug 15, 2001.
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