Infectious complications and morbidities after neonatal bloodstream infections: An observational cohort study

Ming Horng Tsai, Chiang Wen Lee, Shih Ming Chu, I-Ta Lee, Reyin Lien, Hsuan Rong Huang, Ming Chou Chiang, Ren Huei Fu, Jen Fu Hsu, Yhu Chering Huang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality. We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs. Of 975 episodes of neonatal BSI, 101 (10.4%) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0-17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6%), major organ dysfunctions after septic shock in 36 episodes (35.6%), and neurological complications after meningitis or septic shock in 34 episodes (33.7%). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3%) neonates, critical discharge in 4 (4.3%), and persistent sequelae in 17 (18.3%). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95% confidence interval [CI], 3.40-9.01), BSI with septic shock (OR, 5.75; 95% CI, 3.51-9.40), and BSI concurrent with meningitis (OR, 9.20; 95% CI, 4.33-19.56). It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.

Original languageEnglish
Article numbere3078
JournalMedicine (United States)
Volume95
Issue number11
DOIs
Publication statusPublished - Jan 1 2016
Externally publishedYes

Fingerprint

Observational Studies
Cohort Studies
Morbidity
Infection
Septic Shock
Meningitis
Newborn Infant
Neonatal Intensive Care Units
Odds Ratio
Confidence Intervals
Logistic Models
Anti-Bacterial Agents
Mortality
Hospital Costs
Length of Stay
Regression Analysis
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Infectious complications and morbidities after neonatal bloodstream infections : An observational cohort study. / Tsai, Ming Horng; Lee, Chiang Wen; Chu, Shih Ming; Lee, I-Ta; Lien, Reyin; Huang, Hsuan Rong; Chiang, Ming Chou; Fu, Ren Huei; Hsu, Jen Fu; Huang, Yhu Chering.

In: Medicine (United States), Vol. 95, No. 11, e3078, 01.01.2016.

Research output: Contribution to journalArticle

Tsai, MH, Lee, CW, Chu, SM, Lee, I-T, Lien, R, Huang, HR, Chiang, MC, Fu, RH, Hsu, JF & Huang, YC 2016, 'Infectious complications and morbidities after neonatal bloodstream infections: An observational cohort study', Medicine (United States), vol. 95, no. 11, e3078. https://doi.org/10.1097/MD.0000000000003078
Tsai, Ming Horng ; Lee, Chiang Wen ; Chu, Shih Ming ; Lee, I-Ta ; Lien, Reyin ; Huang, Hsuan Rong ; Chiang, Ming Chou ; Fu, Ren Huei ; Hsu, Jen Fu ; Huang, Yhu Chering. / Infectious complications and morbidities after neonatal bloodstream infections : An observational cohort study. In: Medicine (United States). 2016 ; Vol. 95, No. 11.
@article{be4765bfc32146768e11ce815b3b0cbc,
title = "Infectious complications and morbidities after neonatal bloodstream infections: An observational cohort study",
abstract = "Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality. We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs. Of 975 episodes of neonatal BSI, 101 (10.4{\%}) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0-17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6{\%}), major organ dysfunctions after septic shock in 36 episodes (35.6{\%}), and neurological complications after meningitis or septic shock in 34 episodes (33.7{\%}). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3{\%}) neonates, critical discharge in 4 (4.3{\%}), and persistent sequelae in 17 (18.3{\%}). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95{\%} confidence interval [CI], 3.40-9.01), BSI with septic shock (OR, 5.75; 95{\%} CI, 3.51-9.40), and BSI concurrent with meningitis (OR, 9.20; 95{\%} CI, 4.33-19.56). It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.",
author = "Tsai, {Ming Horng} and Lee, {Chiang Wen} and Chu, {Shih Ming} and I-Ta Lee and Reyin Lien and Huang, {Hsuan Rong} and Chiang, {Ming Chou} and Fu, {Ren Huei} and Hsu, {Jen Fu} and Huang, {Yhu Chering}",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000003078",
language = "English",
volume = "95",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Infectious complications and morbidities after neonatal bloodstream infections

T2 - An observational cohort study

AU - Tsai, Ming Horng

AU - Lee, Chiang Wen

AU - Chu, Shih Ming

AU - Lee, I-Ta

AU - Lien, Reyin

AU - Huang, Hsuan Rong

AU - Chiang, Ming Chou

AU - Fu, Ren Huei

AU - Hsu, Jen Fu

AU - Huang, Yhu Chering

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality. We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs. Of 975 episodes of neonatal BSI, 101 (10.4%) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0-17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6%), major organ dysfunctions after septic shock in 36 episodes (35.6%), and neurological complications after meningitis or septic shock in 34 episodes (33.7%). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3%) neonates, critical discharge in 4 (4.3%), and persistent sequelae in 17 (18.3%). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95% confidence interval [CI], 3.40-9.01), BSI with septic shock (OR, 5.75; 95% CI, 3.51-9.40), and BSI concurrent with meningitis (OR, 9.20; 95% CI, 4.33-19.56). It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.

AB - Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality. We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs. Of 975 episodes of neonatal BSI, 101 (10.4%) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0-17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6%), major organ dysfunctions after septic shock in 36 episodes (35.6%), and neurological complications after meningitis or septic shock in 34 episodes (33.7%). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3%) neonates, critical discharge in 4 (4.3%), and persistent sequelae in 17 (18.3%). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95% confidence interval [CI], 3.40-9.01), BSI with septic shock (OR, 5.75; 95% CI, 3.51-9.40), and BSI concurrent with meningitis (OR, 9.20; 95% CI, 4.33-19.56). It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.

UR - http://www.scopus.com/inward/record.url?scp=84962027563&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962027563&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000003078

DO - 10.1097/MD.0000000000003078

M3 - Article

C2 - 26986139

AN - SCOPUS:84962027563

VL - 95

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 11

M1 - e3078

ER -