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Impact of healthcare-associated sepsis on mortality in critically ill infants

Evelien Verstraete (UGent) , Ludo Mahieu, Kris De Coen (UGent) , Dirk Vogelaers (UGent) and Stijn Blot (UGent)
(2016) EUROPEAN JOURNAL OF PEDIATRICS. 175(7). p.943-952
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Abstract
Healthcare-associated sepsis (HAS) is a life-threatening complication in neonatal intensive care. Research into the impact of HAS on mortality adjusted for comorbidities is however limited. We conducted a historical cohort study to evaluate impact of HAS on mortality stratified by birth weight and risk factors for mortality in the HAS cohort. HAS was defined according to the National Institute of Child Health and Human Development criteria. Logistic regression was used to calculate adjusted odds of mortality. Of 5134 admissions, 342 infants developed HAS (6.7 %). Mortality in the total and HAS cohort was 5.6 and 10.5 %, respectively. The majority of HAS was caused by commensals (HAS-COM, 59.4 %) and 40.6 % by recognized pathogens (HAS-REC). Adjusted for comorbidities, "HAS-REC" is only a risk factor for mortality in newborns > 1500 g (adjusted odds ratio [aOR] 2.3, confidence interval [CI] 1.1-4.9). Post-hoc analysis identified HAS-REC as an independent risk factor for mortality in infants with gastrointestinal disease (aOR 4.8, CI 2.1-10.8). "Renal insufficiency," "focal intestinal perforation," and "necrotizing enterocolitis" are independent risk factors for mortality in the HAS cohort (aOR 13.5, CI 4.9-36.6; aOR 7.7, CI 1.5-39.2; aOR 2.1, CI 1.0-4.7, respectively). Conclusion: For very low birth weight infants (<= 1500 g), several comorbidities overrule the impact of HAS on mortality. After adjustment for comorbidities, HAS-REC independently predicts in-hospital mortality in heavier infants and in those with gastrointestinal disease.
Keywords
Newborn, Cross infection, Sepsis, Mortality, Survival analysis, Logistic regression, BLOOD-STREAM INFECTIONS, NEONATAL RESEARCH NETWORK, BIRTH-WEIGHT INFANTS, LATE-ONSET SEPSIS, RISK-FACTORS, NOSOCOMIAL INFECTION, UNITS, SYSTEM, PERIOD, STAY

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Citation

Please use this url to cite or link to this publication:

MLA
Verstraete, Evelien et al. “Impact of Healthcare-associated Sepsis on Mortality in Critically Ill Infants.” EUROPEAN JOURNAL OF PEDIATRICS 175.7 (2016): 943–952. Print.
APA
Verstraete, E., Mahieu, L., De Coen, K., Vogelaers, D., & Blot, S. (2016). Impact of healthcare-associated sepsis on mortality in critically ill infants. EUROPEAN JOURNAL OF PEDIATRICS, 175(7), 943–952.
Chicago author-date
Verstraete, Evelien, Ludo Mahieu, Kris De Coen, Dirk Vogelaers, and Stijn Blot. 2016. “Impact of Healthcare-associated Sepsis on Mortality in Critically Ill Infants.” European Journal of Pediatrics 175 (7): 943–952.
Chicago author-date (all authors)
Verstraete, Evelien, Ludo Mahieu, Kris De Coen, Dirk Vogelaers, and Stijn Blot. 2016. “Impact of Healthcare-associated Sepsis on Mortality in Critically Ill Infants.” European Journal of Pediatrics 175 (7): 943–952.
Vancouver
1.
Verstraete E, Mahieu L, De Coen K, Vogelaers D, Blot S. Impact of healthcare-associated sepsis on mortality in critically ill infants. EUROPEAN JOURNAL OF PEDIATRICS. 2016;175(7):943–52.
IEEE
[1]
E. Verstraete, L. Mahieu, K. De Coen, D. Vogelaers, and S. Blot, “Impact of healthcare-associated sepsis on mortality in critically ill infants,” EUROPEAN JOURNAL OF PEDIATRICS, vol. 175, no. 7, pp. 943–952, 2016.
@article{7205978,
  abstract     = {Healthcare-associated sepsis (HAS) is a life-threatening complication in neonatal intensive care. Research into the impact of HAS on mortality adjusted for comorbidities is however limited. We conducted a historical cohort study to evaluate impact of HAS on mortality stratified by birth weight and risk factors for mortality in the HAS cohort. HAS was defined according to the National Institute of Child Health and Human Development criteria. Logistic regression was used to calculate adjusted odds of mortality. Of 5134 admissions, 342 infants developed HAS (6.7 %). Mortality in the total and HAS cohort was 5.6 and 10.5 %, respectively. The majority of HAS was caused by commensals (HAS-COM, 59.4 %) and 40.6 % by recognized pathogens (HAS-REC). Adjusted for comorbidities, "HAS-REC" is only a risk factor for mortality in newborns > 1500 g (adjusted odds ratio [aOR] 2.3, confidence interval [CI] 1.1-4.9). Post-hoc analysis identified HAS-REC as an independent risk factor for mortality in infants with gastrointestinal disease (aOR 4.8, CI 2.1-10.8). "Renal insufficiency," "focal intestinal perforation," and "necrotizing enterocolitis" are independent risk factors for mortality in the HAS cohort (aOR 13.5, CI 4.9-36.6; aOR 7.7, CI 1.5-39.2; aOR 2.1, CI 1.0-4.7, respectively). 
Conclusion: For very low birth weight infants (<= 1500 g), several comorbidities overrule the impact of HAS on mortality. After adjustment for comorbidities, HAS-REC independently predicts in-hospital mortality in heavier infants and in those with gastrointestinal disease.},
  author       = {Verstraete, Evelien and Mahieu, Ludo and De Coen, Kris and Vogelaers, Dirk and Blot, Stijn},
  issn         = {0340-6199},
  journal      = {EUROPEAN JOURNAL OF PEDIATRICS},
  keywords     = {Newborn,Cross infection,Sepsis,Mortality,Survival analysis,Logistic regression,BLOOD-STREAM INFECTIONS,NEONATAL RESEARCH NETWORK,BIRTH-WEIGHT INFANTS,LATE-ONSET SEPSIS,RISK-FACTORS,NOSOCOMIAL INFECTION,UNITS,SYSTEM,PERIOD,STAY},
  language     = {eng},
  number       = {7},
  pages        = {943--952},
  title        = {Impact of healthcare-associated sepsis on mortality in critically ill infants},
  url          = {http://dx.doi.org/10.1007/s00431-016-2726-6},
  volume       = {175},
  year         = {2016},
}

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