title: Risk factors of late-onset neonatal sepsis in Taiwan: A matched case-control study.
abstract: BACKGROUND
  Infants in a neonatal intensive care unit (NICU) have a higher incidence of bloodstream infections (BSIs) than any other pediatric or adult population. The predisposing factors have not been comprehensively evaluated in this population in Taiwan.
  
  
  METHODS
  A retrospective matched case-control study was conducted in the NICUs of a teaching hospital in Taiwan. The case patients were identified from a staff-maintained electronic database containing the records of BSIs from July 2003 to June 2006. The case patients and the control patients (who did not develop BSI during their NICU stay) were 1:1 matched by birth weight, gestational age, gender, Apgar score, and date of birth.
  
  
  RESULTS
  A total of 164 infants with culture-proven BSI were identified. Of these, 74 (45.1%) infants were female. The mean gestational age and birth weight were 30.7 ± 0.7 weeks and 1512 ± 804 g, respectively. The common etiologic pathogens included coagulase-negative staphylococci (28.7%), Staphylococcus aureus (16.5%), and Klebsiella pneumoniae (14.6%). Candida spp. accounted for 11 (6.7%) episodes. Two independent factors associated with BSIs in the neonates, as identified by multivariate analysis using conditional logistic regression, were the use of parenteral nutrition (matched odds ratio [mOR], 6.07; 95% confidence interval [CI], 1.14-32.32; p = 0.034) and intraventricular hemorrhage (mOR, 2.68; 95% CI, 1.20-5.99; p = 0.017).
  
  
  CONCLUSIONS
  Parenteral nutrition was a significant and independent risk of late-onset neonatal sepsis. This risk should be considered when implementing early parenteral nutrition in NICUs.
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Hsiang
authors.initials: YH
authors.lastname: Kung
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Hsieh
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Weng
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Rey-In
authors.initials: RI
authors.lastname: Lien
authors.affiliation: Division of Neonatology, Department of Pediatrics, Xiamen Chang Gung Hospital, Xiamen, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Luo
authors.affiliation: Division of Neonatology, Department of Pediatrics, Xiamen Chang Gung Hospital, Xiamen, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Molecular Infectious Diseases Medical Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chyi-Liang
authors.initials: CL
authors.lastname: Chen
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: chinjung@adm.cgmh.org.tw.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D000071074:Neonatal Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D010288:Parenteral Nutrition / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology
keywords: Bloodstream infections; Neonates; Parenteral nutrition; Risk factors