Affiliations: Division of Newborn Medicine, Department of
Pediatrics, The Mount Sinai School of Medicine, New York, NY, USA | Department of Health Policy, Division of General
Pediatrics, The Mount Sinai School of Medicine, New York, NY, USA | Department of Pathology, Division of Clinical
Microbiology, Weill Cornell Medical College, New York, NY, USA | Division of Pediatric Infectious Diseases, Department
of Pediatrics, Albert Einstein School of Medicine, Bronx, NY, USA
Note: [] Corresponding author: Kathleen Gibbs, MD, Division of Newborn
Medicine, The Mount Sinai School of Medicine, Box 1508, One Gustave L. Levy
Place, New York, NY 10029, USA. Tel.: +1 212 241 6186; Fax: +1 212 534 5207;
E-mail: [email protected]
Abstract: Objective: To review the epidemiology of late-onset bloodstream
infections (LOBSI), evaluate risk factors associated with LOBSI and to compare
our findings with the literature in light of new National Healthcare Safety
Network (NHSN) birth weight categories. Design/methods: A retrospective
case-controlled study of infants with LOBSI at ⩾ 72 hours of life
admitted to the NICU between 2000 and 2005. Infection rates were determined for
birth weight categories adopted by the NHSN. The exposures of cases and
controls to established risk factors were compared. Antimicrobial
susceptibility patterns were evaluated. Results: A total of 4061 neonates
were studied. LOBSI occurred in 150 (3.7%) of infants. Out of these 150, 196
episodes of infection occurred with 210 isolated pathogens. Most cases of LOBSI
were in the infants whose birth weight was < 1000 grams (ELBW). Sepsis was
associated with increased mortality (23%) in very low birth weight infants
(p< 0.05). Coagulase-negative staphylococci were responsible for most
cases; LOBSI due to Candidal infections were less common but associated with
high mortality rates (37%) in the ELBW infant. Rates of
methicillin-resistant Staphylococcus aureus remained low. Infants who
developed LOBSI had prolonged exposures to a number of established risk
factors. In the logistic regression analysis, bacteremia was associated with
use of parenteral nutrition (OR =5.9) and umbilical catherization (OR=
32). Conclusions: ELBW infants had the highest rates of LOBSI. There was
a low overall incidence of LOBSI due to yeast. However, infections with a
Candida species were more common in ELBW infants and were associated with a
higher mortality.
