title: Infectious Complications and Morbidities After Neonatal Bloodstream Infections: An Observational Cohort Study.
abstract: Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality. We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs. Of 975 episodes of neonatal BSI, 101 (10.4%) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0-17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6%), major organ dysfunctions after septic shock in 36 episodes (35.6%), and neurological complications after meningitis or septic shock in 34 episodes (33.7%). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3%) neonates, critical discharge in 4 (4.3%), and persistent sequelae in 17 (18.3%). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95% confidence interval [CI], 3.40-9.01), BSI with septic shock (OR, 5.75; 95% CI, 3.51-9.40), and BSI concurrent with meningitis (OR, 9.20; 95% CI, 4.33-19.56). It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.
authors.affiliation: From the Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin (M-HT); Department of Nursing, Division of Basic Medical Sciences and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Chiayi (C-WL); Department of Anatomy, College of Medicine, China Medical University, Taichung (I-TL); Division of Pediatric Infectious Disease (Y-CH); Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital (S-MC, RL, H-RH, M-CC, R-HF, J-FH); and College of Medicine, Chang Gung University, Taoyuan, Taiwan (M-HT, S-MC, RL, H-RH, M-CC, R-HF, J-FH, Y-CH).
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Chiang-Wen
authors.initials: CW
authors.lastname: Lee
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: I-Ta
authors.initials: IT
authors.lastname: Lee
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000151:congenital / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology