Clinical Features of Late-Onset Sepsis with Fatal Outcome in Early Phase of Infection in Neonatal Intensive Care Unit Patients and Impact of Initial Antibiotic Therapy

Choi, Jin Hyuck; Kim, Chun Soo; Lee, Sang Lak

Abstract

PURPOSE
Late-onset sepsis (LOS) is a serious problem in the neonatal intensive care unit (NICU). This study was undertaken to investigate clinical features of LOS (occurring after 72 hours of age) with fatal outcome (lethal within 72 hours of onset) in early phase of infection in NICU patients and impact of initial antibiotic therapy.
METHODS
Retrospective analysis of the medical records was conducted to find LOS in patients in a NICU of university hospital over an 8-year period (2001-2008).
RESULTS
There were 455 episodes of blood culture-proven LOS in 388 (6.9%) of 5,608 infants who survived beyond 3 days of age. Gram-positive bacteria were the most common pathogen, accounting for 265 cases (58.2%), and were followed by fungi with 101 cases (22.2%) and Gram-negative bacteria with 89 cases (19.6%). Fatal outcome in early phase of infection occurred in 14 cases (3.1%), and the most prevalent organism of fatal infection was Klebsiella, accounting for 7 cases (50%). Both Candida and S. aureus caused 2 cases of sepsis with fatal outcome, and also Acinetobacter, E. coli and Enterococcus caused 1 case respectively. The fatal outcome was more frequently developed in patients with Gram-negative sepsis than those with Gram-positive or fungal infections (10.1% vs. 2.0% vs. 1.1%; P <0.05). In clinical findings of patients with fatal outcome, the median of age at onset of infection was 19 days (range: 6-94 days), and the interval between onset and death was 29 hours (range: 10-58 hours). Severe sepsis at onset of infection was developed in 7 cases (50.0%), and the use of adequate empirical antibiotics was done in 10 cases (71.4%) of them.
CONCLUSION
LOS by Gram-negative bacteria may easily complicate with fatal outcome in neonates. It cannot be prevented with adequate empirical antibiotic therapy, and additional countermeasures against fatal infection are necessary in NICU.