title: Neonatal gram-negative bacillary late-onset sepsis: A case-control-control study on a prospectively collected database of 5,233 admissions.
abstract: BACKGROUND
  Gram-negative bacillary (GNB) bloodstream infections account for 20%-30% of neonatal late-onset sepsis (LOS). We aimed to identify the incidence, clinical characteristics, and risk factors for adverse outcomes in neonates with GNB LOS.
  
  
  METHODS
  All patients with GNB LOS admitted to the neonatal intensive care units (NICUs) of a university-affiliated teaching hospital in Taiwan from January 1, 2004-December 31, 2011, were enrolled. A case-control-control study was performed to evaluate risk factors for acquisition of neonatal GNB LOS.
  
  
  RESULTS
  Of the 5,010 neonates, 290 (5.8%) had a total of 346 episodes of GNB LOS (36.7% of total LOS), with an incidence rate of 13.6 per 10,000 neonate hospital days. The overall mortality rate was 17.6% (51/290), and the sepsis attributable mortality rate was 9.8% (34/346 episodes). After multivariate logistic regression analysis, neonates with prolonged use of total parenteral nutrition (adjusted odds ratio [OR] = 1.53; 95% confidence interval [CI], 1.02-2.29; P = .041) were independently associated with acquisition of GNB LOS. The independent predictors of in-hospital mortality were Pseudomonas aeruginosa etiology (OR = 11.45; 95% CI, 2.83-46.24) and underlying secondary pulmonary hypertension (OR = 18.02; 95% CI, 3.28-98.89), renal disease (OR = 17.16; 95% CI, 2.96-99.38), and neuromuscular comorbidities (OR = 2.72; 95% CI, 1.06-7.00).
  
  
  CONCLUSIONS
  Given the higher illness severity and sepsis-attributable mortality rate of neonatal GNB LOS in the NICU, strategies to reduce the incidence need to be addressed urgently.
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, Chia-Yi, Taiwan.
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: I Hsyuan
authors.initials: IH
authors.lastname: Wu
authors.affiliation: Department of Nursing, Division of Basic Medical Sciences and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chia-Yi, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
authors.forename: Chiang-Wen
authors.initials: CW
authors.lastname: Lee
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: jeff0724@gmail.com.
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: ychuang@adm.cgmh.org.tw.
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D016470:Bacteremia / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000502:physiology*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D009468:Neuromuscular Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000502:physiology; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology
keywords: Antibiotic resistance; Bloodstream infection; Gram-negative bacilli; Late-onset sepsis; Risk factors