Risk factors associated with laboratory-confirmed bloodstream infections in a tertiary neonatal intensive care unit.
BACKGROUND
Bloodstream infections (BSI) remain a leading cause of morbidity and mortality among infants admitted to neonatal intensive care units (NICUs). At the time of evaluation for suspected BSI, presenting signs may be nonspecific. We sought to determine the clinical signs and risk factors associated with laboratory-confirmed BSI among infants evaluated for late-onset sepsis in a tertiary NICU.


METHODS
This prospective cohort study included infants >3 days of age admitted to a level 4 NICU from July 2006 to October 2009 for whom a blood culture was drawn for suspected sepsis. Clinicians documented presenting signs at the time of culture. Laboratory-confirmed BSI was defined as per the National Healthcare Safety Network. Multivariate analyses were performed using a logistic regression random effects model.


RESULTS
Six-hundred and eighty eligible episodes of suspected BSI were recorded in 409 infants. Enteral contrast within the preceding 48 hours was the most significant risk factor for laboratory-confirmed BSI [Odds Ratio: 9.58 (95% confidence interval: 2.03-45.19)] followed by presence of a central venous catheter. Apnea and hypotension were the most strongly associated presenting signs.


CONCLUSIONS
Among infants evaluated in a tertiary NICU, recent exposure to enteral contrast was associated with increased odds of developing BSI. Apnea and hypotension were the most strongly associated clinical signs of infection.
From the *Division of Neonatology; †Department of Pediatrics, The Children's Hospital of Philadelphia; ‡Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; §Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; ¶Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; and ‖Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA.
Michael A
MA
Padula
Maya L
ML
Dewan
Samir S
SS
Shah
Amy M
AM
Padula
Lakshmi
L
Srinivasan
Karin L
KL
McGowan
Kaitilin R
KR
Mahoney
Mary C
MC
Harris
D001049:Apnea / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D062606:Tertiary Care Centers