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

Alberto Berardi, Francesca Sforza, Lorenza Baroni, Caterina Spada, Simone Ambretti, Giacomo Biasucci, Serenella Bolognesi, Mariagrazia Capretti, Edoardo Carretto, Matilde Ciccia, Marcello Lanari, Maria Federica Pedna, Vittoria Rizzo, Claudia Venturelli, Crisoula Tzialla, Laura Lucaccioni, Maria Letizia Bacchi Reggiani

Research output: Contribution to journalArticle

Abstract

Background 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. Methods 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). Results 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. Conclusions 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.

Original languageEnglish
Article numbere0225407
JournalPLoS One
Volume14
Issue number11
DOIs
Publication statusPublished - Jan 1 2019

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Epidemiology
sepsis (infection)
epidemiology
Sepsis
Pathogens
neonates
Newborn Infant
low birth weight
meningitis
Live Birth
Escherichia coli
Meningitis
Brain
Streptococcus agalactiae
pathogens
gestational age
Anti-Bacterial Agents
Cerebrospinal fluid
Low Birth Weight Infant
death

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Berardi, A., Sforza, F., Baroni, L., Spada, C., Ambretti, S., Biasucci, G., ... Reggiani, M. L. B. (2019). Epidemiology and complications of late-onset sepsis: An Italian area-based study. PLoS One, 14(11), [e0225407]. https://doi.org/10.1371/journal.pone.0225407

Epidemiology and complications of late-onset sepsis : An Italian area-based study. / Berardi, Alberto; Sforza, Francesca; Baroni, Lorenza; Spada, Caterina; Ambretti, Simone; Biasucci, Giacomo; Bolognesi, Serenella; Capretti, Mariagrazia; Carretto, Edoardo; Ciccia, Matilde; Lanari, Marcello; Pedna, Maria Federica; Rizzo, Vittoria; Venturelli, Claudia; Tzialla, Crisoula; Lucaccioni, Laura; Reggiani, Maria Letizia Bacchi.

In: PLoS One, Vol. 14, No. 11, e0225407, 01.01.2019.

Research output: Contribution to journalArticle

Berardi, A, Sforza, F, Baroni, L, Spada, C, Ambretti, S, Biasucci, G, Bolognesi, S, Capretti, M, Carretto, E, Ciccia, M, Lanari, M, Pedna, MF, Rizzo, V, Venturelli, C, Tzialla, C, Lucaccioni, L & Reggiani, MLB 2019, 'Epidemiology and complications of late-onset sepsis: An Italian area-based study', PLoS One, vol. 14, no. 11, e0225407. https://doi.org/10.1371/journal.pone.0225407
Berardi A, Sforza F, Baroni L, Spada C, Ambretti S, Biasucci G et al. Epidemiology and complications of late-onset sepsis: An Italian area-based study. PLoS One. 2019 Jan 1;14(11). e0225407. https://doi.org/10.1371/journal.pone.0225407
Berardi, Alberto ; Sforza, Francesca ; Baroni, Lorenza ; Spada, Caterina ; Ambretti, Simone ; Biasucci, Giacomo ; Bolognesi, Serenella ; Capretti, Mariagrazia ; Carretto, Edoardo ; Ciccia, Matilde ; Lanari, Marcello ; Pedna, Maria Federica ; Rizzo, Vittoria ; Venturelli, Claudia ; Tzialla, Crisoula ; Lucaccioni, Laura ; Reggiani, Maria Letizia Bacchi. / Epidemiology and complications of late-onset sepsis : An Italian area-based study. In: PLoS One. 2019 ; Vol. 14, No. 11.
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title = "Epidemiology and complications of late-onset sepsis: An Italian area-based study",
abstract = "Background 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. Methods 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). Results 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. Conclusions 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.",
author = "Alberto Berardi and Francesca Sforza and Lorenza Baroni and Caterina Spada and Simone Ambretti and Giacomo Biasucci and Serenella Bolognesi and Mariagrazia Capretti and Edoardo Carretto and Matilde Ciccia and Marcello Lanari and Pedna, {Maria Federica} and Vittoria Rizzo and Claudia Venturelli and Crisoula Tzialla and Laura Lucaccioni and Reggiani, {Maria Letizia Bacchi}",
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T1 - Epidemiology and complications of late-onset sepsis

T2 - An Italian area-based study

AU - Berardi, Alberto

AU - Sforza, Francesca

AU - Baroni, Lorenza

AU - Spada, Caterina

AU - Ambretti, Simone

AU - Biasucci, Giacomo

AU - Bolognesi, Serenella

AU - Capretti, Mariagrazia

AU - Carretto, Edoardo

AU - Ciccia, Matilde

AU - Lanari, Marcello

AU - Pedna, Maria Federica

AU - Rizzo, Vittoria

AU - Venturelli, Claudia

AU - Tzialla, Crisoula

AU - Lucaccioni, Laura

AU - Reggiani, Maria Letizia Bacchi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background 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. Methods 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). Results 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. Conclusions 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.

AB - Background 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. Methods 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). Results 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. Conclusions 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.

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