title: Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors.
abstract: BACKGROUND
  Bloodstream infection represents a major threat among neonates under intensive care with considerable impact on morbidity and mortality. This study evaluated extra stay, attributable mortality and the risk factors associated with late-onset bloodstream infection (LO-BSI) among neonates admitted to a neonatal intensive care unit during a 4-year period.
  
  
  METHODS
  A retrospective matched cohort study was conducted. For each case, there was one control patient without LO-BSI matched for sex, birth weight, gestational age, duration of hospitalization prior to the date of LO-BSI in the respective cases, underlying illness and birth date. A novel test, sequential plan, was employed for attributable mortality analysis in addition to standard tests. Multiple logistic regression was employed for risk factor analysis.
  
  
  RESULTS
  Fifty pairs of cases and controls were compared. LO-BSI prolonged hospital stay of 25.1 days in pairs where both subjects survived. Overall attributable mortality was 24% (95% CI: 9-39% p < 0.01) and specific attributable mortality due to Staphylococcus epidermidis was 26.7% (95% CI: 23-30.4%; p = 0.01). Blood and/or blood components transfusion was independently associated with neonatal LO-BSI (OR: 21.2; 95% CI: 1.1-423).
  
  
  CONCLUSIONS
  LO-BSI infection prolongs hospital stay and is associated with increased mortality among neonates. In the present series, blood transfusion was a significant risk factor for LO-BSI.
authors.affiliation: Federal University of Rio de Janeiro, Brazil. c.l.pessoa-silva@hcuge.ch
authors.forename: C L
authors.initials: CL
authors.lastname: Pessoa-Silva
authors.forename: C H
authors.initials: CH
authors.lastname: Miyasaki
authors.forename: M F
authors.initials: MF
authors.lastname: de Almeida
authors.forename: B I
authors.initials: BI
authors.lastname: Kopelman
authors.forename: R L
authors.initials: RL
authors.lastname: Raggio
authors.forename: S B
authors.initials: SB
authors.lastname: Wey
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology / Q000401:mortality*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D018709:Statistics, Nonparametric