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

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.