title: Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants.
abstract: BACKGROUND
  Neonatal sepsis contributes to great mortality and morbidity among very-low-birth-weight (VLBW) infants. Prevalence and pathogen distribution of sepsis in the neonatal intensive care units (NICUs) vary with time and geographic location. Such information serves as a guide for selection of empirical antibiotics coverage.
  
  
  METHODS
  This is a case series study performed by retrospective chart review of VLBW infants (birth body weight, BBW, <1500 g) in a medical center during a 5-year period from January 2005 to December 2009. Episodes of positive blood cultures, pathogen distribution and related clinical manifestations were described.
  
  
  RESULTS
  A total of 158 episodes of sepsis were identified from 1042 VLBW infants. Sepsis rate was 152 per 1000 live births. The vast majority of infections (60.7%) were caused by Gram-positive organisms [G(+)], and overall Coagulase-negative staphylococci (CoNS) (52.5%) were the most common pathogen identified. Prevalence for early-onset sepsis (EOS) was 1% and for late-onset sepsis (LOS) was 14.2%. Infants with EOS had a much higher case fatality rate than LOS (40% vs. 4.7%). Escherichia coli (40%) were the leading pathogen of EOS while CoNS (54.7%) was the leading pathogens of LOS. Overall, apnea and/or bradycardia and/or cyanosis (65.8%), poor activity (48.7%), and increased respiratory effort (43.0%) were the most common presenting features of sepsis.
  
  
  CONCLUSIONS
  Unlike term infants, Gram-negative organism and E coli were the leading pathogen of EOS among VLBW infants. Judicious and timely use of antibiotic therapy is crucial in the care of VLBW infants.
authors.affiliation: Division of Neonatology, Chang Gung Children's Hospital, School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
authors.forename: Wai Ho
authors.initials: WH
authors.lastname: Lim
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.forename: Peng-Hong
authors.initials: PH
authors.lastname: Yang
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D013624:Taiwan / Q000453:epidemiology