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Updated: Apr 27, 2026
A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a
Mohan Pammi1, Danni Zhong, Yvette Johnson
1Section of Neonatology, Department of Pediatrics, Texas Children's Hospital & Baylor College of Medicine, 6621, Fannin, MC: WT 6-104, Houston, TX 77030, USA. mohanv@bcm.edu.
Insights
Polymicrobial bloodstream infections in neonatal intensive care units (NICUs) are common and significantly increase mortality risk. Surgical intervention is a key risk factor, highlighting the need for increased clinical awareness and research.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Critical Care
Background:
- Polymicrobial infections increase mortality, ICU stay, and healthcare costs in adults and children.
- Limited characterization of polymicrobial bloodstream infections (PBSI) in neonatal units exists.
- Significant variation in PBSI incidence and outcomes necessitates further study.
Purpose of the Study:
- To characterize risk factors and outcomes of PBSI in a North American tertiary hospital's neonatal units.
- To compare PBSI with monomicrobial bloodstream infections (MBSI) in neonates.
Main Methods:
- Retrospective case-control study design.
- Identified neonates with positive blood cultures in the NICU over 16 years (1997-2012).
- Matched PBSI cases with three MBSI controls by gestational age and birth weight.
Main Results:
- 14% of 2007 bloodstream infections were polymicrobial.
- Common genera: Coagulase-negative Staphylococcus, Enterococcus, Klebsiella, Candida.
- PBSI associated with >3-fold increase in mortality and longer infection duration.
- Surgical intervention identified as a significant risk factor for PBSI.
Conclusions:
- PBSI are clinically significant in the NICU due to high frequency and mortality.
- Urgent need for increased clinical awareness and focused research on neonatal PBSI.
Background:
Polymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs. Very few studies have characterized polymicrobial bloodstream infections in the neonatal unit. Considerable variation has been reported in incidence of polymicrobial infections and associated clinical outcomes. We characterized the risk factors and outcomes of polymicrobial bloodstream infections in our neonatal units in a tertiary hospital in North America.
Methods:
In a retrospective case control study design, we identified infants in the neonatal intensive care unit with positive blood cultures at Texas Children's Hospital, over a 16-year period from January 1, 1997 to December 31, 2012. Clinical data from online databases were available from January 2009 to December 2012. For each polymicrobial bloodstream infection (case), we matched three infants with monomicrobial bloodstream infection (control) by gestational age and birth weight.
Results:
We identified 2007 episodes of bloodstream infections during the 16 year study period and 280 (14%) of these were polymicrobial. Coagulase-negative Staphylococcus, Enterococcus, Klebsiella and Candida were the most common microbial genera isolated from polymicrobial infections. Polymicrobial bloodstream infections were associated with more than 3-fold increase in mortality and an increase in duration of infection. Surgical intervention was a significant risk factor for polymicrobial infection.
Conclusion:
The frequency and increased mortality emphasizes the clinical significance of polymicrobial bloodstream infections in the neonatal intensive care unit. Clinical awareness and focused research on neonatal polymicrobial infections is urgently needed.
