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Updated: Dec 28, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Multidrug-resistant Gram-negative bacilli sepsis from a neonatal intensive care unit: a case-case-control study
Anucha Thatrimontrichai1, Nutchana Premprat2, Waricha Janjindamai3
1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. tanucha@medicine.psu.ac.th.
Introduction:
To identify the risks and outcomes for multidrug-resistant Gram-negative bacilli (MDRGNB) sepsis in neonates.
Methodology:
This was a retrospective case-case-control study between 1991 and 2016. The control group was selected from the same source records of all neonates with clinical or suspected sepsis but not culture-proven.
Results:
The numbers of patients in the MDRGNB sepsis, non-MDRGNB sepsis, and control groups were 157, 88, and 218, respectively. MDRGNB sepsis was significantly associated with outborn infants [adjusted odds ratio (aOR) 2.08; p = 0.003] and infants who had a neurologic sequela (aOR 11.58; p = 0.04), lower gestational age (p = 0.03) or previous aminoglycoside use (aOR 2.43; p < 0.001) compared with the control group. Non-MDRGNB sepsis was associated with outborn infants (aOR 2.63; p < 0.001), and infants who had neurologic sequelae (aOR 48.25; p = 0.001) and previous cephalosporin use (aOR 6.28; p < 0.001) or cefoperazone plus sulbactam use (aOR 6.48; p = 0.02) compared with the control group. Case fatality (OR 3.63; p < 0.001) and septic shock (OR 12.81; p < 0.001) rates, length of stay (p < 0.001), and daily hospital costs (p = 0.01) were higher in the MDRGNB sepsis group than in the control group.
Conclusions:
Smaller preterm neonate with previous aminoglycoside use had a higher MDRGNB than non-MDRGNB sepsis compared with the control group. Intervention to reduce MDRGNB sepsis in the NICU is cost-effective.
Insights
Multidrug-resistant Gram-negative bacilli (MDRGNB) sepsis in neonates is linked to adverse outcomes and increased costs. Interventions to reduce MDRGNB sepsis in neonatal intensive care units (NICUs) are cost-effective.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Critical Care
Background:
- Neonatal sepsis remains a significant cause of morbidity and mortality worldwide.
- Multidrug-resistant Gram-negative bacilli (MDRGNB) pose a growing threat in neonatal intensive care units (NICUs).
- Understanding the specific risks and outcomes associated with MDRGNB sepsis is crucial for effective management.
Purpose of the Study:
- To identify risk factors and clinical outcomes for neonates with multidrug-resistant Gram-negative bacilli (MDRGNB) sepsis.
- To compare these risks and outcomes against non-MDRGNB sepsis and a control group without culture-proven sepsis.
Main Methods:
- Retrospective case-case-control study conducted between 1991 and 2016.
- Inclusion of three groups: MDRGNB sepsis, non-MDRGNB sepsis, and a control group (suspected sepsis without culture confirmation).
- Statistical analysis using adjusted odds ratios (aOR) to determine significant associations.
Main Results:
- MDRGNB sepsis was associated with outborn infants, neurologic sequelae, lower gestational age, and prior aminoglycoside use.
- Non-MDRGNB sepsis was linked to outborn infants, neurologic sequelae, and prior cephalosporin or cefoperazone/sulbactam use.
- Higher case fatality rates, septic shock, longer hospital stays, and increased daily costs were observed in the MDRGNB sepsis group compared to controls.
Conclusions:
- Smaller preterm neonates with prior aminoglycoside exposure are at higher risk for MDRGNB sepsis.
- Interventions aimed at reducing MDRGNB sepsis in the NICU setting are likely to be cost-effective.
- The findings underscore the importance of targeted prevention and management strategies for MDRGNB infections in neonates.
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