Giannoni E, et al. - Authors evaluated the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). In neonates, a high burden of sepsis was seen with considerable mortality and morbidity. Specific patient subgroups were affected by EOS, hospital-acquired LOS, and community-acquired LOS and these subgroups have a distinct clinical presentation, pathogens, and outcomes.

Methods

• In this study, experts included all newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015.
• EOS was defined as an infection occurring <3 days after birth, and LOS as infection ≥3 days after birth.
• They classified the infants with LOS as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission.
• They estimated the incidence based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study.

Results

• As per data, 444 episodes of blood culture-proven sepsis were identified in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS.
• Findings suggested that the estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths.
• Results demonstrated that the hospital-acquired LOS vs EOS occurred in infants of lower gestational age and was more frequently associated with comorbidities.
• In term infants and in male infants, community-acquired LOS was more common.
• In EOS, hospital-acquired LOS, and community-acquired LOS, mortality was 18%, 12%, and 0%, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation.