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Patterns of Infections among Extremely Preterm Infants

Infections remain a leading cause of neonatal death, especially among the extremely preterm infants. To evaluate the incidence, pathogenesis, and in-hospital outcomes associated with sepsis among hospitalized extremely preterm infants born at 24–0/7 to 27–6/7 weeks of gestation, we designed a post h...

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Autores principales: Perez, Krystle, Puia-Dumitrescu, Mihai, Comstock, Bryan A., Wood, Thomas R., Mayock, Dennis E., Heagerty, Patrick J., Juul, Sandra E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095151/
https://www.ncbi.nlm.nih.gov/pubmed/37048786
http://dx.doi.org/10.3390/jcm12072703
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author Perez, Krystle
Puia-Dumitrescu, Mihai
Comstock, Bryan A.
Wood, Thomas R.
Mayock, Dennis E.
Heagerty, Patrick J.
Juul, Sandra E.
author_facet Perez, Krystle
Puia-Dumitrescu, Mihai
Comstock, Bryan A.
Wood, Thomas R.
Mayock, Dennis E.
Heagerty, Patrick J.
Juul, Sandra E.
author_sort Perez, Krystle
collection PubMed
description Infections remain a leading cause of neonatal death, especially among the extremely preterm infants. To evaluate the incidence, pathogenesis, and in-hospital outcomes associated with sepsis among hospitalized extremely preterm infants born at 24–0/7 to 27–6/7 weeks of gestation, we designed a post hoc analysis of data collected prospectively during the Preterm Epo Neuroprotection (PENUT) Trial, NCT #01378273. We analyzed culture positive infection data, as well as type and duration of antibiotic course and described their association with in-hospital morbidities and mortality. Of 936 included infants, 229 (24%) had at least one positive blood culture during their hospitalization. Early onset sepsis (EOS, ≤3 days after birth) occurred in 6% of the infants, with Coagulase negative Staphylococci (CoNS) and Escherichia Coli the most frequent pathogens. Late onset sepsis (LOS, >day 3) occurred in 20% of the infants. Nearly all infants were treated with antibiotics for presumed sepsis at least once during their hospitalization. The risk of confirmed or presumed EOS was lower with increasing birthweight. Confirmed EOS had no significant association with in-hospital outcomes or death while LOS was associated with increased risk of necrotizing enterocolitis and death. Extremely premature infants with presumed sepsis as compared to culture positive sepsis had lower rates of morbidities. In conclusion, the use of antibiotics for presumed sepsis remains much higher than confirmed infection rates. Ongoing work exploring antibiotic stewardship and presumed, culture-negative sepsis in extremely preterm infants is needed.
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spelling pubmed-100951512023-04-13 Patterns of Infections among Extremely Preterm Infants Perez, Krystle Puia-Dumitrescu, Mihai Comstock, Bryan A. Wood, Thomas R. Mayock, Dennis E. Heagerty, Patrick J. Juul, Sandra E. J Clin Med Article Infections remain a leading cause of neonatal death, especially among the extremely preterm infants. To evaluate the incidence, pathogenesis, and in-hospital outcomes associated with sepsis among hospitalized extremely preterm infants born at 24–0/7 to 27–6/7 weeks of gestation, we designed a post hoc analysis of data collected prospectively during the Preterm Epo Neuroprotection (PENUT) Trial, NCT #01378273. We analyzed culture positive infection data, as well as type and duration of antibiotic course and described their association with in-hospital morbidities and mortality. Of 936 included infants, 229 (24%) had at least one positive blood culture during their hospitalization. Early onset sepsis (EOS, ≤3 days after birth) occurred in 6% of the infants, with Coagulase negative Staphylococci (CoNS) and Escherichia Coli the most frequent pathogens. Late onset sepsis (LOS, >day 3) occurred in 20% of the infants. Nearly all infants were treated with antibiotics for presumed sepsis at least once during their hospitalization. The risk of confirmed or presumed EOS was lower with increasing birthweight. Confirmed EOS had no significant association with in-hospital outcomes or death while LOS was associated with increased risk of necrotizing enterocolitis and death. Extremely premature infants with presumed sepsis as compared to culture positive sepsis had lower rates of morbidities. In conclusion, the use of antibiotics for presumed sepsis remains much higher than confirmed infection rates. Ongoing work exploring antibiotic stewardship and presumed, culture-negative sepsis in extremely preterm infants is needed. MDPI 2023-04-04 /pmc/articles/PMC10095151/ /pubmed/37048786 http://dx.doi.org/10.3390/jcm12072703 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Perez, Krystle
Puia-Dumitrescu, Mihai
Comstock, Bryan A.
Wood, Thomas R.
Mayock, Dennis E.
Heagerty, Patrick J.
Juul, Sandra E.
Patterns of Infections among Extremely Preterm Infants
title Patterns of Infections among Extremely Preterm Infants
title_full Patterns of Infections among Extremely Preterm Infants
title_fullStr Patterns of Infections among Extremely Preterm Infants
title_full_unstemmed Patterns of Infections among Extremely Preterm Infants
title_short Patterns of Infections among Extremely Preterm Infants
title_sort patterns of infections among extremely preterm infants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095151/
https://www.ncbi.nlm.nih.gov/pubmed/37048786
http://dx.doi.org/10.3390/jcm12072703
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