Factors associated with persistent bloodstream infection in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Clinical Microbiology

Background:

• Bloodstream infections (BSIs) are a significant concern in neonatal intensive care units (NICUs).
• Identifying factors predicting persistent BSIs is crucial for optimizing patient management and antibiotic stewardship.
• Follow-up blood cultures (FUBCs) are used to confirm infection resolution, but their utility can vary.

Purpose of the Study:

• To determine clinical and microbiological factors associated with persistent BSIs in NICU infants.
• To identify specific patient and pathogen characteristics that indicate increased utility for FUBCs.

Main Methods:

• A single-center retrospective study analyzed data from 121 NICU infants with positive blood cultures over five years.
• Bivariate and multi-regression analyses were used to identify predictors of persistent BSI, defined as the same organism growing >48 hours after the initial culture.
• Clinical variables including sex, catheter presence, and sepsis onset timing were examined alongside microbiological data.

Main Results:

• Staphylococcus aureus recovery (OR=6.10), male sex (OR=3.31), and central venous catheter presence (OR=3.73) were significantly associated with persistent BSIs.
• BSIs occurring in the context of late-onset sepsis were also linked to persistence (p<0.001).
• No persistent BSIs were observed in infants with early-onset sepsis or those infected with Streptococcal species.

Conclusions:

• Patient and microbial factors significantly influence the likelihood of persistent BSIs in the NICU.
• These characteristics can guide diagnostic stewardship decisions regarding the necessity and timing of FUBCs.
• Targeted use of FUBCs based on identified risk factors can improve resource allocation and patient care.