Pediatrics & Neonatology
Volume 50, Issue 3 , Pages 88-95, June 2009

Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan

  • Jun-Ho Wu

      Affiliations

    • Department of Pediatrics, Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
    • Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Chien-Yi Chen

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Po-Nien Tsao

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Wu-Shiun Hsieh

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Hung-Chieh Chou

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 8, Chung-Shan South Road, Taipei, Taiwan

Received 24 June 2008; received in revised form 30 September 2008; accepted 17 October 2008.

Article Outline

Background

Neonatal sepsis is the most serious problem in neonatal intensive care, resulting in significant morbidity and mortality. We evaluated the causative pathogen, drug sensitivity, hematological parameters, clinical course and mortality rate of neonatal sepsis in a Taiwanese medical center and compared our results to those of previous studies conducted in Taiwan.

Methods

Neonates admitted to the neonatal intensive care unit (NICU) at National Taiwan University Hospital (NTUH) between January 2001 and December 2006 were included in this study. Patients were divided into early-onset sepsis and late-onset sepsis groups if their culture tested positive within the first 7 days of life or later, respectively.

Results

A total of 109 episodes of sepsis were identified in 100 neonates. The incidence of sepsis was 4.06% among all NICU admissions. Most neonates with early-onset sepsis were term infants, while very low birth weight (VLBW) and preterm infants accounted for the majority of cases of late-onset sepsis. In early-onset sepsis, the most common pathogens responsible included group B streptococci (GBS) (36%) and Escherichia coli (E. coli) (26%). GBS was associated with more meningitis involvement but lower incidence of mortality compared with E. coli. The most common causative micro organisms in late-onset sepsis were coagulase-negative staphylococci (CONS) (40%) and Candida (15%). The sepsis-related mortality rates were higher in early-onset sepsis (10%) than in late-onset sepsis (7%).

Conclusion

Unlike previous reports from Taiwan, in the present study, GBS was found to be the leading pathogen in early-onset sepsis. GBS screening and intrapartum antibiotic prophylaxis guidelines should be used in Taiwan to prevent early neonatal sepsis. The most common causative microorganisms of late-onset sepsis were CONS and Candida species. Candida parapsilosis was associated with a high mortality rate.

Key Words:  neonatal intensive care unit , neonatal sepsis

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References 

  1. Berger A , Salzer HR , Weninger M , Sageder B , Aspock C . Septicaemia in an Austrian neonatal intensive care unit: a 7-year analysis . Acta Paediatr . 1998;87:1066–1069
  2. Stoll BJ , Hansen N , Fanaroff AA , et al.   Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network . Pediatrics . 2002;110:285–291
  3. Jiang JH , Chiu NC , Huang FY , et al.   Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset . J Microbiol Immunol Infect . 2004;37:301–306
  4. Park CH , Seo JH , Lim JY , Woo HO , Youn HS . Changing trend of neonatal infection: experience at a newly established regional medical center in Korea . Pediatr Int . 2007;49:24–30
  5. Stoll BJ , Hansen N , Fanaroff AA , et al.   Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants . N Engl J Med . 2002;347:240–247
  6. Su BH , Hsieh HY , Chiu HY , Lin HC , Lin HC . Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan . Am J Infect Control . 2007;35:190–195
  7. Gaynes RP , Edwards JR , Jarvis WR , Culver DH , Tolson JS , Martone WJ . Nosocomial infections among neonates in highrisk nurseries in the United States. National Nosocomial Infections Surveillance System . Pediatrics . 1996;98:357–361
  8. Lee NC , Chen SJ , Tang RB , Hwang BT . Neonatal bacteremia in a neonatal intensive care unit: analysis of causative organisms and antimicrobial susceptibility . J Chin Med Assoc . 2004;67:15–20
  9. Ku-Nein Wei F-YH , Yen-Chin Lee , Chen-Chue Wu . Clinical observation of neonatal septicemia . Acta Paed Sin . 1986;27:409–418
  10. Wei SH , Chiu HH , Hung KC , et al.   Epidemiologic trends in nosocomial bacteremia in a neonatal intensive care unit . J Microbiol Immunol Infect . 2005;38:283–288
  11. Tseng YC , Chiu YC , Wang JH , et al.   Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review . J Microbiol Immunol Infect . 2002;35:168–172
  12. Lukacs SL , Schoendorf KC , Schuchat A . Trends in sepsisrelated neonatal mortality in the United States, 1985–1998 . Pediatr Infect Dis J . 2004;23:599–603
  13. Lopez Sastre JB , Fernandez Colomer B , Coto Cotallo GD , Ramos Aparicio A . Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention . Acta Paediatr . 2005;94:451–457
  14. Cheng PJ , Shaw SW , Lin PY , Huang SY , Soong YK . Maternal anxiety about prenatal screening for group B streptococcus disease and impact of positive colonization results . Eur J Obstet Gynecol Reprod Biol . 2006;128:29–33
  15. Fu JC . Antibiotic susceptibility pattern of anovaginal isolates of streptococcus agalactiae from pregnant women in their late third trimester . Kaohsiung J Med Sci . 2004;20:330–333
  16. Friedman S , Shah V , Ohlsson A , Matlow AG . Neonatal escherichia coli infections: concerns regarding resistance to current therapy . Acta Paediatr . 2000;89:686–689
  17. Terrone DA , Rinehart BK , Einstein MH , Britt LB , Martin JN , Perry KG . Neonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration . Am J Obstet Gynecol . 1999;180:1345–1348
  18. Maayan-Metzger A , Linder N , Marom D , Vishne T , Ashkenazi S , Sirota L . Clinical and laboratory impact of coagulasenegative staphylococci bacteremia in preterm infants . Acta Paediatr . 2000;89:690–693
  19. Karlowicz MG , Buescher ES , Surka AE . Fulminant late-onset sepsis in a neonatal intensive care unit, 1988–1997, and the impact of avoiding empiric vancomycin therapy . Pediatrics . 2000;106:1387–1390
  20. Rubin LG , Sanchez PJ , Siegel J , Levine G , Saiman L , Jarvis WR . Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists' practices . Pediatrics . 2002;110:e42
  21. Waggoner-Fountain LA , Walker MW , Hollis RJ , et al.   Vertical and horizontal transmission of unique Candida species to premature newborns . Clin Infect Dis . 1996;22:803–808
  22. Levy I , Shalit I , Askenazi S , Klinger G , Sirota L , Linder N . Duration and outcome of persistent candidaemia in newborn infants . Mycoses . 2006;49:197–201
  23. Kossoff EH , Buescher ES , Karlowicz MG . Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases . Pediatr Infect Dis J . 1998;17:504–508
  24. Weems JJ . Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility . Clin Infect Dis . 1992;14:756–766
  25. Levy I , Rubin LG , Vasishtha S , Tucci V , Sood SK . Emergence of Candida parapsilosis as the predominant species causing candidemia in children . Clin Infect Dis . 1998;26:1086–1088
  26. Huang YC , Lin TY , Lien RI , et al.   Candidaemia in special care nurseries: comparison of albicans and parapsilosis infection . J Infect . 2000;40:171–175
  27. Strausbaugh LJ , Sewell DL , Ward TT , Pfaller MA , Heitzman T , Tjoelker R . High frequency of yeast carriage on hands of hospital personnel . J Clin Microbiol . 1994;32:2299–2300
  28. Huang YC , Lin TY , Leu HS , Peng HL , Wu JH , Chang HY . Outbreak of Candida parapsilosis fungemia in neonatal intensive care units: clinical implications and genotyping analysis . Infection . 1999;27:97–102
  29. Ng PC , Lam HS . Diagnostic markers for neonatal sepsis . Curr Opin Pediatr . 2006;18:125–131
  30. Khassawneh M , Hayajneh WA , Kofahi H , Khader Y , Amarin Z , Daoud A . Diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6 and immunoglobulin M . Scand J Immunol . 2007;65:171–175
  31. Hsiao CR , Huang L , Bouchara JP , Barton R , Li HC , Chang TC . Identification of medically important molds by an oligonucleotide array . J Clin Microbiol . 2005;43:3760–3768
  32. Chen CC , Teng LJ , Chang TC . Identification of clinically relevant viridans group streptococci by sequence analysis of the 16S-23S ribosomal DNA spacer region . J Clin Microbiol . 2004;42:2651–2657

PII: S1875-9572(09)60042-5

doi:10.1016/S1875-9572(09)60042-5

Pediatrics & Neonatology
Volume 50, Issue 3 , Pages 88-95, June 2009

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