title: A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam.
abstract: OBJECTIVE
  The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam.
  
  
  METHODS
  A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis.
  
  
  RESULTS
  Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%.
  
  
  CONCLUSIONS
  Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.
authors.affiliation: Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.|Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
authors.forename: H T
authors.initials: HT
authors.lastname: Tran
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.|Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: L W
authors.initials: LW
authors.lastname: Doyle
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.
authors.forename: N M
authors.initials: NM
authors.lastname: Dang
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000150:Acinetobacter / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control; D007363:Intensive Care Units, Neonatal; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D015999:Multivariate Analysis; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D014744:Vietnam
chemical_list: D000900:Anti-Bacterial Agents