Postconception age and other risk factors associated with mortality following Gram-negative rod bacteremia.
BACKGROUND
Neonatal nosocomial Gram-negative rod bacteremia (GNR-b) is considered ominous.


METHODS
Multi-center cohort study of premature infants (N=6172) who had a blood culture after day of life 3 and whose birthweight was < or =1250 g.


RESULTS
A total of 437 neonates developed GNR-b; most commonly with Klebsiella (122/437; 28%), Enterobacter (97/437; 22%), Escherichia coli (90/437; 21%), Pseudomonas (63/437; 14%), and Serratia (49/437; 11%). Neonates infected with Pseudomonas were more likely to die (21/63; 33%) than infants infected with other GNR (50/374; 13%). In multivariable logistic regression, infection with Pseudomonas, mechanical ventilation, and race were associated with subsequent mortality. Postconception age (PCA) was most strongly associated with mortality. Using neonates with >34 weeks PCA at the time of the first blood culture as the reference category, mortality was higher in neonates <26 weeks PCA (odds ratio (OR)=9.21; 95% confidence interval (CI)=2.79, 30.44), and in neonates 26 to 28 weeks PCA (OR=3.94; 95% CI=1.29, 12.03).


CONCLUSIONS
Among premature infants, much of the mortality experienced in GNR-b is due to infection with Pseudomonas rather than enteric GNR. Race, the need for mechanical ventilation, and younger PCA when the blood culture was obtained were also strongly associated with mortality.
Benjamin
Daniel K
DK
Duke Clinical Research Institute, Durham, NC 27715, USA.
DeLong
Elizabeth R
ER
Cotten
Charles M
CM
Garges
Harmony P
HP
Clark
Reese H
RH
D000367:Age Factors; D016470:Bacteremia / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D004756:Enterobacteriaceae Infections / Q000401:mortality; D004927:Escherichia coli Infections / Q000401:mortality; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality*; D007710:Klebsiella Infections / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D011552:Pseudomonas Infections / Q000401:mortality; D012307:Risk Factors; D016868:Serratia Infections / Q000401:mortality