title: Incidence, aetiology and resistance of late-onset neonatal sepsis: a five-year prospective study.
abstract: OBJECTIVE
  Investigate the incidence, etiological pattern and the antimicrobial resistance of late-onset neonatal infections over a period of 5 years.
  
  
  METHODS
  Longitudinal audit of neonatal sepsis from January 2005 to December 2009, in the main maternity hospital in Kuwait. Late-onset neonatal infection was defined as the culture of a single potentially pathogenic organism from blood or cerebrospinal fluid from an infant older than 6 days in association with clinical or laboratory findings consistent with infection.
  
  
  RESULTS
  The overall incidence was 16.9 (95% confidence interval: 15.8-18.0) episodes per 1000 live births. The commonest pathogen was coagulase-negative Staphylococcus, 339 (35.7%), while Klebsiella was the most common gram-negative infection, 178 (18.8%). Escherichia coli, Enterococcus and Enterobacter spp were each responsible for 6% of all infections. Candida caused 104 (11.0%) infections. The general pattern of infection remained unchanged over the study period. Case fatality was 11.7% (95% confidence interval: 9.7-13.9%) and was high for Pseudomonas (18.4%) and Candida (22.1%) infections. Approximately 24 and 20% of Klebsiella infections were resistant to cefotaxime and gentamicin, respectively, while 28 and 24% of Escherichia coli infections were resistant to cefotaxime and gentamicin, respectively.
  
  
  CONCLUSIONS
  The incidence of late-onset infection in Kuwait is high, resembling that in resource-poor countries. The high incidence coupled with low case fatality provides an example for settings where tertiary care is introduced without strict measures against nosocomial infections. Prevention against nosocomial infections in neonatal units has the potential to further reduce neonatal mortality in these settings.
authors.affiliation: Department of Pediatrics Community Medicine, Kuwait University, Kuwait, Kuwait. m.hammoud@hsc.edu.kw
authors.forename: Majeda S
authors.initials: MS
authors.lastname: Hammoud
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.forename: Lukman
authors.initials: L
authors.lastname: Thalib
authors.forename: Noura
authors.initials: N
authors.lastname: Al-Sweih
authors.forename: Seema
authors.initials: S
authors.lastname: Pathan
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002177:Candidiasis / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006771:Hospitals, Maternity; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007730:Kuwait / Q000453:epidemiology; D008485:Medical Audit; D011446:Prospective Studies