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Updated: Feb 27, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Pathogen-specific mortality in very low birth weight infants with primary bloodstream infection
Brar C Piening1, Christine Geffers1, Petra Gastmeier1
1Institute for Hygiene and Environmental Medicine, Charité University Medical Center, Berlin, Germany.
Insights
Gram-negative bacteria bloodstream infections in very low birth weight infants significantly increase mortality risk compared to Staphylococcus aureus. Fungal infections like Candida albicans did not show a higher risk, warranting targeted prevention strategies.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Public Health
Background:
- Mortality rates in very low birth weight (VLBW) infants vary by pathogen type in primary bloodstream infections.
- Previous studies suggest Gram-negative bacteria and fungi are associated with higher case fatality risks.
Purpose of the Study:
- To confirm if Gram-negative bacteria and fungi cause a higher case fatality risk in VLBW infants with bloodstream infections.
- To compare case fatality risks across different pathogens in a nationwide multi-center trial.
Main Methods:
- A nationwide cohort of 55,465 VLBW infants from 242 neonatal departments in Germany was analyzed.
- Cox proportional hazard regression was used to assess the risk of death following microbiology-confirmed primary bloodstream infections.
- Analyses were adjusted for known risk factors and hospital characteristics.
Main Results:
- The overall crude case fatality risk for VLBW infants with bloodstream infections was 5.7%.
- Infections caused by Klebsiella spp., Enterobacter spp., Escherichia coli, and Serratia spp. were associated with significantly higher case fatality risks compared to Staphylococcus aureus.
- Candida albicans infections did not show a statistically significant higher case fatality risk than Staphylococcus aureus after adjustments.
Conclusions:
- Gram-negative pathogen bloodstream infections in VLBW infants are linked to increased case fatality compared to Gram-positive pathogens.
- Findings highlight the need to consider pathogen-specific risks in prevention and therapeutic strategies for VLBW infants.
- Further research is recommended to understand the specific risk factors for Candida albicans bloodstream infections in this population.
Objective:
Mortality in very low birth weight infants following microbiology confirmed primary bloodstream infections varies with the type of causative pathogen. Given evidence from other studies that infections with gram negative bacteria and fungi cause a higher case fatality risk. We tried to confirm this in a nation-wide multi-center trial.
Methods:
A cohort of 55,465 very low birth weight infants from 242 neonatal departments participating in the German national neonatal infection surveillance system NEO-KISS was used to investigate differences in the case fatality risk of microbiology confirmed primary bloodstream infections according to individual pathogens. Cox proportional hazard regression analyses were performed with the outcomes death and time from microbiology confirmed primary bloodstream infections. The results were adjusted to the recorded risk factors and hospital and department characteristics.
Results:
A total of 4 094 very low birth weight infants with microbiology confirmed primary bloodstream infections were included in the analysis. The crude case fatality risk was 5.7%. The Cox proportional hazard regression analysis with adjustment for available risk factors revealed that microbiology confirmed primary bloodstream infections caused by Klebsiella spp. (HR 3.17 CI95 1.69-5.95), Enterobacter spp. (HR 3.42 CI95 1.86-6.27), Escherichia coli (HR 3.32 CI95 1.84-6.00) and Serratia spp. (HR 3.30 CI95 1.44-7.57) were associated with significantly higher case fatality risk compared to Staphylococcus aureus. After adjusting, case fatality risk of Candida albicans causing microbiology confirmed primary bloodstream infections was not higher than that of S. aureus.
Conclusion:
In very low birth weight infants, bloodstream infections caused by gram negative pathogens have an increased case fatality risk compared to bloodstream infections caused by gram positive pathogens. This should be considered for prevention and therapy. Further research should address the specific risk factors for case fatality of C. albicans bloodstream infections.
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