Sepsis in young infants with congenital heart disease.
BACKGROUND
We sought to describe the incidence, pathogen distribution, and mortality associated with blood culture-proven sepsis in young infants with congenital heart disease (CHD) admitted to a neonatal intensive care unit (NICU).


METHODS
Cohort study of all blood cultures obtained from infants with CHD between 4 and 120 days of age cared for in 250 NICUs managed by the Pediatrix Medical Group in the United States between 1996 and 2007.


RESULTS
Of 11,638 infants with CHD, 656 (6%) had 821 episodes of sepsis: a cumulative incidence of 71/1000 admissions. Gram-positive organisms were the most common cause (64%), and coagulase-negative Staphylococcus and Staphylococcus aureus were the most frequently isolated species. On multivariable regression, infants with sepsis were more likely to die compared to infants with sterile blood cultures (odds ratio [OR] = 1.53 [95% confidence interval: 1.09, 2.13]). Infants with Gram-negative bacteraemia and candidaemia were more likely to die than infants with sterile blood cultures (OR = 2.01 [1.20, 3.37], and OR = 3.18 [1.60, 6.34], respectively).


CONCLUSIONS
Infants with CHD have a high incidence of culture-proven sepsis, especially with staphylococcal organisms. Gram-negative bacteraemia and candidaemia are strongly associated with increased mortality in this group of young infants.
Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
S B
SB
Ascher
P B
PB
Smith
R H
RH
Clark
M
M
Cohen-Wolkowiez
J S
JS
Li
K
K
Watt
E
E
Jacqz-Aigrain
F
F
Kaguelidou
P
P
Manzoni
D K
DK
Benjamin
D058387:Candidemia / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D013210:Staphylococcus / Q000302:isolation & purification