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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis

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Risk Factors for 30-Day Mortality in Neonatal Gram-Negative Bacilli Sepsis

Anucha Thatrimontrichai1, Nutchana Premprat2, Waricha Janjindamai1

  • 1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

American Journal of Perinatology
|May 16, 2019
PubMed
Abstract

Insights

Multidrug-resistant gram-negative bacilli (MDR-GNB) sepsis in neonates has a high case fatality rate (CFR). Septic shock and lack of microbiological cure significantly increase mortality risk in these vulnerable infants.

Area of Science:

  • Neonatal Intensive Care Unit (NICU) research
  • Infectious Diseases
  • Microbiology

Background:

  • Multidrug-resistant gram-negative bacilli (MDR-GNB) pose a significant global health threat, particularly in neonatal intensive care units (NICUs).
  • Gram-negative bacilli (GNB) sepsis in neonates is associated with a high case fatality rate (CFR), demanding urgent investigation into risk factors.

Purpose of the Study:

  • To identify risk factors associated with the 30-day CFR in neonatal GNB sepsis.
  • To analyze the impact of MDR-GNB on neonatal sepsis outcomes in a Thai NICU.

Main Methods:

  • A 27-year case-control study (1991-2017) was conducted in a Thai NICU.
  • Cox's proportional hazards model was employed to analyze the 30-day CFR and identify risk factors.
  • Data included gestational age, birth weight, and microbiological cure rates.

Main Results:

  • MDR-GNB accounted for 66% of GNB sepsis cases over 27 years.
  • The 30-day CFR was significantly higher for MDR-GNB sepsis (33%) compared to non-MDR-GNB sepsis (20%) (HR=1.74).
  • Neonates with GNB sepsis experiencing septic shock (aHR=6.67) or lacking microbiological cure (aHR=10.65) had significantly higher mortality.

Conclusions:

  • Neonatal GNB sepsis, especially when caused by MDR-GNB, carries a substantial mortality risk.
  • Prompt broad-spectrum empirical antimicrobial therapy is crucial for neonates with suspected sepsis and septic shock, particularly in high MDR prevalence areas.
  • Achieving microbiological cure is a critical factor in improving survival rates for neonatal GNB sepsis.

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