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

Verstraete, Evelien Hilde, Mahieu, Ludo, De Coen, Kris, Vogelaers, Dirk and Blot, Stijn (2016) Impact of healthcare-associated sepsis on mortality in critically ill infants. European Journal of Pediatrics, 175 7: 943-952. doi:10.1007/s00431-016-2726-6


Author Verstraete, Evelien Hilde
Mahieu, Ludo
De Coen, Kris
Vogelaers, Dirk
Blot, Stijn
Title Impact of healthcare-associated sepsis on mortality in critically ill infants
Journal name European Journal of Pediatrics   Check publisher's open access policy
ISSN 1432-1076
0340-6199
Publication date 2016-07-01
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s00431-016-2726-6
Open Access Status Not yet assessed
Volume 175
Issue 7
Start page 943
End page 952
Total pages 10
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2017
Language eng
Formatted 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.

What is Known: The relationship between healthcare-associated sepsis and mortality is influenced by the causative pathogen and is confounded by comorbidities. Research on impact of healthcare-associated sepsis on mortality adjusted for comorbidities is limited as well as research on independent risk factors for mortality in neonates with sepsis.

What is New: We included a large list of comorbidities and stratified risk by birth weight in order to assess the true effect of healthcare-associated sepsis on mortality. Risk for mortality was calculated for commensal flora and for recognized pathogens as causative micro-organisms.
Keyword Cross infection
Logistic regression
Mortality
Newborn
Sepsis
Survival analysis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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