title: Late-onset bloodstream infections in hospitalized term infants.
abstract: BACKGROUND
  The epidemiology and incidence of late-onset blood stream infections (BSIs) in premature infants have been described, but studies describing late-onset BSI in term infants are sparse. We sought to describe the pathogens, incidence, risk factors and mortality of late-onset BSI in hospitalized term infants.
  
  
  METHODS
  A cohort study was conducted of infants ≥37 weeks gestational age and ≤120 days of age discharged from Pediatrix Medical Group neonatal intensive care units from 1997 to 2010. We examined all cultures obtained from day of life 4-120 and used multivariable regression to assess risk factors for late-onset BSI.
  
  
  RESULTS
  We found a total of 206,019 infants cared for between day of life 4 and 120, and the incidence of late-onset BSI was 2.7/1000 admissions. We identified Gram-positive organisms in 64% of the cultures and Gram-negative organisms in 26%. We found a decreased risk of late-onset BSI in infants with the following characteristics: small for gestational age, delivery by Cesarean, antenatal antibiotic use and discharged in the later years of the study. Late-onset BSI increased the risk of death after controlling for confounders [odds ratio 8.43 (95% confidence interval 4.42-16.07)].
  
  
  CONCLUSIONS
  Our data highlight the importance of late-onset BSI in hospitalized term infants. We identified Gram-positive organisms as the most common pathogen, and late-onset BSI was an independent risk factor for death.
authors.affiliation: From the *Duke Clinical Research Institute, Durham, NC; †Division of Neonatal Medicine, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil; ‡Department of Pediatrics, Duke University, Durham, NC; §Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL; and ¶Department of Economics, Clemson University, Clemson, SC.
authors.forename: Daniela
authors.initials: D
authors.lastname: Testoni
authors.forename: Madoka
authors.initials: M
authors.lastname: Hayashi
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D009181:Mycoses / Q000150:complications / Q000453:epidemiology; D011295:Prenatal Care; D012307:Risk Factors; D047929:Term Birth; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents