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Risk factors for late onset gram-negative infections: a case-control study.

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Late onset gram-negative sepsis and meningitis (LOGNS) predominantly affects very low birthweight infants. The duration of total parenteral nutrition (TPN) is the sole independent risk factor identified for this serious neonatal infection.

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Area of Science:

  • Neonatalogy
  • Infectious Diseases
  • Pediatric Critical Care

Background:

  • Late onset gram-negative sepsis and meningitis (LOGNS) is a significant cause of morbidity and mortality in neonatal intensive care units.
  • Identifying risk factors is crucial for implementing targeted preventive strategies.

Purpose of the Study:

  • To determine the incidence, mortality, and risk factors associated with neonatal late onset gram-negative sepsis and meningitis (LOGNS).

Main Methods:

  • A retrospective case-control study was conducted in a tertiary neonatal unit.
  • Inborn infants with late onset (>48 hours of life) invasive gram-negative infections were identified and compared to matched healthy controls.
  • Clinical and risk factor data were collected and analyzed.

Main Results:

  • The incidence of LOGNS was 1.85 per 1000 live births, predominantly affecting very low birthweight (VLBW) infants (79%).
  • Common pathogens included Enterobacter spp., Escherichia coli, and Klebsiella spp.
  • While univariate analysis showed associations with mechanical ventilation, TPN, central venous lines, and necrotizing enterocolitis, only the duration of TPN remained an independent risk factor in multivariate analysis.

Conclusions:

  • LOGNS primarily impacts VLBW infants.
  • The duration of total parenteral nutrition (TPN) is the only independent risk factor for LOGNS when gestational age is considered.
  • These findings highlight the importance of optimizing TPN strategies in VLBW infants to reduce the risk of gram-negative infections.