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

INTRODUCTION

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

MATERIALS AND

METHODS

Study

Design

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

PARTICIPANTS

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

RESULTS

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.

CONCLUSION

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.