Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors.
BACKGROUND
Polymicrobial bloodstream infections (PBSIs) have been associated with complex underlying medical conditions and a high incidence of specific microorganisms in several settings, but the relevant data are scarce in neonates.


METHODS
Positive blood cultures from January 2004 to December 2011 in the neonatal intensive care unit (NICU) of Chang Gung Memorial Hospital (CGMH) were reviewed. Each neonate with PBSI (case episode) was matched to two episodes of monomicrobial BSI (control episode) by birth weight, gestational age and gender. Records were reviewed to compare their underlying medical conditions, organisms isolated, adequacy of therapy, clinical characteristics and outcomes.


RESULTS
Forty-five episodes of PBSI (4.4% of all neonatal BSIs) were identified in 43 neonates. Gram-negative organisms constituted 59.8% of all PBSI pathogens, and 33 (73.3%) of PBSIs were caused by at least one Gram-negative organism. PBSIs were significantly more likely to be the recurrent episode and have endotracheal tube in place. No significant difference was found between PBSIs and controls in terms of demographics and most chronic conditions. PBSIs were significantly associated with a higher severity of illness, a longer duration of septic symptoms, and a higher rate of modification of antimicrobial regimens than monomicrobial BSIs. However, the sepsis-attributable mortality rates were comparable between these two groups.


CONCLUSIONS
In the NICU, PBSIs were more often caused by Gram-negative bacilli, and often occurred in neonates without any chronic conditions. The clinical significance of PBSIs included a more severe illness, longer duration of septic symptoms and a higher rate of modification of antimicrobial regimens.
Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan ; Chang Gung University of Science and Technology, Chiayi, Taiwan.
Ming-Horng
MH
Tsai
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Shih-Ming
SM
Chu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Jen-Fu
JF
Hsu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Reyin
R
Lien
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Hsuan-Rong
HR
Huang
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ming-Chou
MC
Chiang
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ren-Huei
RH
Fu
Chang Gung University of Science and Technology, Chiayi, Taiwan.
Chiang-Wen
CW
Lee
Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Yhu-Chering
YC
Huang
D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors
D000890:Anti-Infective Agents