title: Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis.
abstract: BACKGROUND
  Late-onset sepsis (LOS) is a common complication in the neonatal intensive care unit. We aimed to describe the epidemiology, clinical characteristics and risk factors for adverse outcome in neonates with LOS.
  
  
  METHODS
  We conducted a cohort study of all neonates with LOS at the neonatal intensive care unit of a Tertiary Taiwan Medical Center from January 2004 through December 2011 and used multivariate logistic regression to identify risk factors for final adverse outcome.
  
  
  RESULTS
  Among 5010 neonates over 253,644 neonate-days, 713 (14.2%) experienced a total of 942 episodes of LOS (incidence rate, 3.71 episodes per 1000 neonate-days). Although the rates of LOS were inversely proportional to birth weight and gestational age, the incidence rates were comparable among extremely preterm, late preterm and full term neonates. Fungemia was found to have significantly higher rate of infectious complication (30.8%), persistent bloodstream infection (19.2%) and sepsis attributable mortality (23.1%). The overall mortality rate was 12.6% (90/713), and sepsis attributable mortality rate was 7.2% (68/942 episodes). Independent predictors of in-hospital mortality were Pseudomonas LOS (adjusted odds ratio [OR], 14.31; 95% confidence interval [CI]: 3.87-53.0), fungemia (OR, 5.69; 95% CI: 2.48-13.01), presence of congenital anomalies (OR, 4.12; 95% CI: 1.60-10.60), neuromuscular comorbidities (OR, 3.34; 95% CI: 1.66-6.73) and secondary pulmonary hypertension with/without cor pulmonale (OR, 23.48; 95% CI: 5.96-92.49).
  
  
  CONCLUSIONS
  LOS predisposes hospitalized neonates to increased risk of mortality or morbidity, especially caused by Pseudomonas aeruginosa or Candida spp. More aggressive treatment strategy is worth consideration in neonates with presumed LOS, particularly those with certain underlying chronic conditions.
authors.affiliation: From the *Department of Pediatrics, Division of Neonatology and Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Yunlin; †College of Medicine, Chang Gung University, Taoyuan; ‡Chang Gung University of Science and Technology, Chiayi; §Department of Pediatrics, Division of Pediatric Neonatology; and ¶Department of Pediatrics, Division of Pediatric Infectious Disease, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Hsuan-Rong
authors.initials: HR
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: Chiang-Wen
authors.initials: CW
authors.lastname: Lee
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D017668:Age of Onset; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology