Distribution of Late-Onset Neonatal Sepsis Pathogens Differs in Inpatient and Outpatient Settings

We sought to examine pathogen distribution and clinical presentation of late-onset sepsis (LOS) at an urban tertiary care center.

We performed a retrospective review of all culture-confirmed cases of LOS presenting to our institution from 2013 to 2017. Medical records were evaluated for demographic information, sepsis risk factors, encounter location, and clinical outcome.

We identified 97 cases of LOS, with a median age at diagnosis of 25 days. The most common pathogens were Escherichia coli (22.7%), Staphylococcus aureus (17.5%), coagulase-negative staphylococci (12.4%), and Enterococcus faecalis (12.4%). Infections due to E. coli predominated in the outpatient setting (44%), whereas S. aureus and Gram-negative organisms other than E. coli were more frequently isolated from inpatients (21 and 24%, respectively). Gram-positive organisms were more common in infants delivered through cesarean section (p = 0.002) and were associated with more complications (p = 0.03). Escherichia coli LOS presented at an earlier age than S. aureus (15 vs. 32 days; p = 0.04). Of the 15 cases of meningitis, 40% did not have a positive blood culture.

Pathogen distribution in our population was different from those previously reported, with a higher prevalence of S. aureus. Encounter location and age at presentation varied significantly by pathogen.