Epidemiology and complications of late-onset sepsis: an Italian area-based study

Autoři: Alberto Berardi aff001;  Francesca Sforza aff002;  Lorenza Baroni aff003;  Caterina Spada aff002;  Simone Ambretti aff004;  Giacomo Biasucci aff005;  Serenella Bolognesi aff006;  Mariagrazia Capretti aff007;  Edoardo Carretto aff008;  Matilde Ciccia aff009;  Marcello Lanari aff010;  Maria Federica Pedna aff011;  Vittoria Rizzo aff012;  Claudia Venturelli aff013;  Crisoula Tzialla aff014;  Laura Lucaccioni aff001;  Maria Letizia Bacchi Reggiani aff015
Působiště autorů: Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy aff001;  Medico in formazione, Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio, Modena, Italy aff002;  Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Arcispedale Santa Maria Nuova, Reggio Emilia, Italy aff003;  Unità Operativa di Microbiologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy aff004;  Unità Operativa di Pediatria, Ospedale G da Saliceto, Piacenza, Italy aff005;  Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi, Rimini, Italy aff006;  Unità Operativa di Neonatologia, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy aff007;  Laboratorio di Microbiologia, Dipartimento Interaziendale di Diagnostica per Immagini e Medicina di Laboratorio, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy aff008;  Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore, Bologna, Italy aff009;  Unità Operativa di Pediatria, Dipartimento Del Bambino, Della Donna E Delle Malattie Urologiche, Azienda Ospedaliero-Universitaria Sant’Orsola–Malpighi, Bologna, Italy aff010;  Unità Operativa di Microbiologia, Laboratorio Unico Ausl della Romagna, Pievesestina Cesena, Italy aff011;  Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini, Cesena, Italy aff012;  Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy aff013;  Neonatologia, Patologia Neonatale e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy aff014;  Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi—Università di Bologna, Bologna, Italy aff015
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225407



Most studies regarding late-onset sepsis (LOS) address selected populations (i.e., neonates with low birth weight or extremely preterm neonates). Studying all age groups is more suitable to assess the burden of single pathogens and their clinical relevance.


This is a retrospective regional study involving paediatric departments and NICUs in Emilia-Romagna (Italy). Regional laboratory databases were searched from 2009 to 2012. Records of infants (aged 4 to 90 days) with a positive blood or cerebrospinal fluid (CSF) culture were retrospectively reviewed and analysed according to acquisition mode (whether hospital- or community-acquired).


During the study period, there were 146,682 live births (LBs), with 296 patients experiencing 331 episodes of LOS (incidence rate: 2.3/1000 LBs). Brain lesions upon discharge from the hospital were found in 12.3% (40/296) of cases, with death occurring in 7.1% (23/296; 0.14/1000 LBs). With respect to full-term neonates, extremely preterm or extremely low birth weight neonates had very high risk of LOS and related mortality (> 100- and > 800-fold higher respectively). Hospital-acquired LOS (n = 209) was significantly associated with very low birth weight, extremely preterm birth, pneumonia, mechanical ventilation, and death (p< 0.01). At multivariate logistic regression analysis, catecholamine support (OR = 3.2), central venous line before LOS (OR = 14.9), and meningitis (OR = 44.7) were associated with brain lesions or death in hospital-acquired LOS (area under the ROC curve 0.81, H-L p = 0.41). Commonly identified pathogens included coagulase-negative staphylococci (CoNS n = 71, 21.4%), Escherichia coli (n = 50, 15.1%), Staphylococcus aureus (n = 41, 12.4%) and Enterobacteriaceae (n = 41, 12.4%). Group B streptococcus was the predominant cause of meningitis (16 of 38 cases, 42%). Most pathogens were sensitive to first line antibiotics.


This study provides the first Italian data regarding late-onset sepsis (LOS) in all gestational age groups. Compared to full-term neonates, very high rates of LOS and mortality occurred in neonates with a lower birth weight and gestational age. Group B streptococcus was the leading cause of meningitis. Excluding CoNS, the predominant pathogens were Escherichia coli and Staphylococcus aureus. Neonates with hospital-acquired LOS had a worse outcome. Antibiotic associations, recommended for empirical treatment of hospital- or community-acquired LOS, were adequate.

Klíčová slova:

Bacterial pathogens – Birth weight – Blood – Fungal pathogens – Meningitis – Neonatal sepsis – Neonates – Nosocomial infections


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