Distribution of Late-Onset Neonatal Sepsis Pathogens Differs in Inpatient and Outpatient Settings
Distribution of Late-Onset Neonatal Sepsis Pathogens Differs in Inpatient and Outpatient Settings
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DOI：
10.1055/s-0038-1675643
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发表时间：
2019-09-01
影响因子：
2
通讯作者：
Randis, Tara M.
中科院分区：
文献类型：
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作者：
Black, Celeste G.;Tavares, Larissa;Randis, Tara M.
目的探讨某城市三级医疗中心迟发性脓毒症（LOS）的病原菌分布和临床表现。研究设计我们对2013年至2017年在我们机构就诊的所有经培养证实的LOS病例进行了回顾性审查。对病历进行人口统计学信息、脓毒症风险因素、就诊地点和临床结局评价。结果我们发现了97例LOS病例，诊断时的中位年龄为25天。最常见的病原体为大肠埃希菌（22.7%）、金黄色葡萄球菌（17.5%）、凝固酶阴性葡萄球菌（12.4%）和粪肠球菌（12.4%）。E.大肠杆菌在门诊中占优势（44%），而S.金黄色葡萄球菌和除E.大肠杆菌更频繁地从住院患者中分离出来（分别为21%和24%）。革兰氏阳性菌在剖宫产婴儿中更常见（p = 0.002），并与更多并发症相关（p = 0.03）。大肠杆菌LOS出现的年龄比S.金黄色葡萄球菌（15 vs. 32天; p = 0.04）。在15例脑膜炎病例中，40%的血培养结果不呈阳性。结论本地区人群病原菌分布与以往报道不同，以S。金黄色。发病地点和发病年龄因病原体而异。
Objective We sought to examine pathogen distribution and clinical presentation of late-onset sepsis (LOS) at an urban tertiary care center. Study Design We performed a retrospective review of all culture-confirmed cases of LOS presenting to our institution from 2013 to 2017. Medical records were evaluated for demographic information, sepsis risk factors, encounter location, and clinical outcome. Results We identified 97 cases of LOS, with a median age at diagnosis of 25 days. The most common pathogens were Escherichia coli (22.7%), Staphylococcus aureus (17.5%), coagulase-negative staphylococci (12.4%), and Enterococcus faecalis (12.4%). Infections due to E. coli predominated in the outpatient setting (44%), whereas S. aureus and Gram-negative organisms other than E. coli were more frequently isolated from inpatients (21 and 24%, respectively). Gram-positive organisms were more common in infants delivered through cesarean section ( p = 0.002) and were associated with more complications ( p = 0.03). Escherichia coli LOS presented at an earlier age than S. aureus (15 vs. 32 days; p = 0.04). Of the 15 cases of meningitis, 40% did not have a positive blood culture. Conclusion Pathogen distribution in our population was different from those previously reported, with a higher prevalence of S. aureus . Encounter location and age at presentation varied significantly by pathogen.