title: Recurrent late-onset sepsis in the neonatal intensive care unit: incidence, clinical characteristics and risk factors.
abstract: We aimed to characterize the incidence, clinical features, risk factors and outcomes of recurrent late-onset sepsis (LOS) in the neonatal intensive care unit (NICU). All neonates with LOS from the NICU of a tertiary-level teaching hospital in northern Taiwan between 2004 and 2011 were enrolled for analyses. A case-control study was performed to determine risk factors for recurrence. Of 713 neonates with LOS, 150 (21.0%) experienced recurrence and 48 (6.7%) had >1 recurrences; c. two-thirds of recurrent LOS occurred in infants with birth weight (BW)≦1500 g or gestational age (GA)≦30 weeks. The recurrent LOS episodes were significantly more severe and had a higher sepsis-attributable mortality rate than the first episodes. The overall in-hospital mortality rate was 30.7% for neonates with recurrent LOS and 7.8% for those with single LOS (odds ratio (OR), 5.22; 95% CI, 3.28-8.30). When both BW and GA were controlled, neonates with recurrent LOS had a significantly prolonged hospitalization compared with the controls (median 109 vs. 84 days, p<0.001). After multivariate logistic regression, longer duration of total parenteral nutrition (TPN; OR, 1.30; 95% CI, 1.10-1.52 for every 10-day increment), presence of congenital anomalies (OR, 2.64; 95% CI, 1.10-6.35) and neurological co-morbidities (OR, 4.14; 95% CI, 1.14-15.10) were identified as the independent risk factors for LOS recurrence. We concluded that c. one-fifth of neonates with LOS had recurrence, which significantly resulted in prolonged hospitalization and increased mortality. Longer TPN administration, presence of congenital anomalies and neurological co-morbidities are independently associated with recurrent LOS.
authors.affiliation: Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Tsai
authors.forename: S-M
authors.initials: SM
authors.lastname: Chu
authors.forename: C-W
authors.initials: CW
authors.lastname: Lee
authors.forename: J-F
authors.initials: JF
authors.lastname: Hsu
authors.forename: H-R
authors.initials: HR
authors.lastname: Huang
authors.forename: M-C
authors.initials: MC
authors.lastname: Chiang
authors.forename: R-H
authors.initials: RH
authors.lastname: Fu
authors.forename: R
authors.initials: R
authors.lastname: Lien
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D013624:Taiwan; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Antibiotic resistance; bacteraemia; late-onset sepsis; recurrence; risk factor