Epidemiology of late-onset sepsis in Malaysian neonatal intensive care units, 2015-2020

To determine the epidemiology of blood culture-positive late-onset sepsis (LOS, >72 hours of age) in 44 Malaysian neonatal intensive care units (NICUs).

Study Design: Multicentre retrospective observational study using data from the Malaysian National Neonatal Registry.

739486 neonates (birthweight ≥500g, gestation ≥22 weeks) born and admitted in 2015-2020.

LOS developed in 2707 (0.4%) neonates. Median annual incidence (per 100 admissions) was 12.0 (range: 8.1-13.8) in extremely preterm (EPT, gestation <28 weeks), 5.3 (range: 5.0-6.8) in very preterm (VPT, gestation 28-<32 weeks), 0.5 (range: 0.4-0.7) in moderate/late preterm (gestation 32-<37 weeks) and 0.1 in term (gestation ≥37 weeks) neonates. Gram-negative bacteria accounted for 54.7% of pathogens isolated, gram-positive bacteria 39.3%, and fungal and other pathogens 6.0%. The six most common pathogens were coagulase-negative Staphylococcus (18.3%), Klebsiella spp. (18.3%), Staphylococcus aureus (9.9%), Pseudomonas spp. (8.9%), Acinetobacter spp. (7.7%) and Escherichia coli (5.9%). LOS-attributable mortality was 14.3% in EPT, 9.3% in VPT, 8.3% in LPT and 6.2% in term neonates. Multiple logistic regression analysis showed that EPT, small-for-gestation (SGA), conventional mechanical ventilation (CMV), high frequency ventilation (HFV), TPN and use of central venous lines (CVL) were significant independent risk factors associated with LOS in neonates <32 weeks' gestation. The significant independent risk factors associated with mortality in neonates with LOS were SGA, CMV, HFV, gram-negative sepsis, fungal sepsis, and pneumothorax.

Gram-negative bacteria were the commonest pathogens. Decreasing the usage of invasive ventilation, CVL and TPN may reduce the incidence and mortality of LOS, particularly in neonates <32 weeks gestation.