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Infection in premature neonates is not associated with higher attributable mortality, but with more neurologic sequellae
International Journal of Antimicrobial Agents 21 (2003) 292 /293 www.isochem.org
Letter Infection in premature neonates is not associated with higher attributable mortality, but with more neurologic sequellae Sir Premature neonates of less than 32 weeks gestation are at high risk for infection [1,2]. We investigated risk factors and outcome of 49 such neonates compared with 197 neonates with longer gestation in a national neonatal clinic in the Slovak Republic over 2-year period. The Table 1 shows a univariate analysis, to assess risk factors for infection in neonates born before 32 weeks gestation (49) versus infection in neonates born after 32 weeks of gestation (197). The use of medical technology, e.g. ventilator support, total parenteral nutrition, percutaneous arterial catheter, and respiratory distress syndrome were significantly more often observed in more premature neonates (B/32 week of gestation) (P 5/0.02, 0.0001, 0.006 and 0.0001). Prolonged rupture of membranes and cerclage were the risk factors from the mother (P 5/0.042 and 0.0009) associated with shorter gestation as well as bacteraemia (P 5/0.0001). Premature infants of B/32 weeks gestation also showed significantly higher infection rates with Klebsiella /Enterobacter spp. (71.43 vs. 38.58%, P 5/0.0001) than premature new-borns of longer gestation. H. influenzae (P 5/0.025) was more common in new-borns of greater than 32 weeks gestation. Diagnostic markers of sepsis e.g. procalcitonin, leukocytes /30 000, and septic score /two points were more frequently observed in new-borns with less than 32 weeks gestation (P 5/0.001, 0.002, and 0.0001). Death from infection (attributable mortality) was similar in both groups, probably because of early empirical therapy with broad-spectrum antibiotics, which were significantly more frequently used in neonates of shorter gestation. Empirical therapy with broad spectrum cephalosporins or carbapenems helps to maintain similar mortality figures from infection in this
high risk group and more mature neonates with less risk factors for infection. The outcome was better among premature new-borns of /32 weeks (98.98 vs. 89.8%, P 5/0.0039) than those of lesser gestation. Death from underlying disease (P 5/0.0075) neurological sequellae of infection, such as brain abscess (P 5/0.039) and intraventricular haemorrhage (P 5/0.0039), were significantly related to prematurity in neonates. A higher rate of meningitis was not seen in this group of neonates.
References [1] Huttova M. Infection diseases in Neonates. University of Trnava, editor. 2001. p. 255. [2] Krcmery V, Paradisi F, et al. Nosocomial bacterial and fungal meningitis in children, an eight year national survey reporting 101 cases. International Journal of Antimicrobial Agents 2000;15:143 / 7.
B.M. Hafed, E. Bilikova, G. Kovacicova, J. Koprnova, V. Krcmery School of Public Health, University of Trnava, Heydukova 10, 812 50 Bratislava, Slovak Republic E-mail address: [email protected] D. Chovancova, M. Drobna, M. Huttova Postgraduate Medicine School, Neonatal Clinic, Heydukova 10, 812 50 Bratislava, Slovak Republic
0924-8579/02/$30 # 2002 Elsevier Science B.V. and the International Society of Chemotherapy. All rights reserved. doi:10.1016/S0924-8579(02)00346-1
Letter to the Editor
293
Table 1 Infections in neonates born before 32 gestational weeks versus neonates born at or after 32 weeks gestation Gestation weeks
Total
B/32 weeks (%)
Baby’s risk factors Umbilical catheters Ventilatory support Total parenteral nurtirion Percutaneous arterial catheter Respiratory diseases
112 37 30 5 11
29 (59) 13 (27) 18 (37) 4 (8) 8 (16)
83 (42) 24 (12) 12 (6) 1 (0) 3 (2)
0.047 0.02 0.0001 0.006 0.0001
Mother’s risk factors Premature rupture of membrane Cerclage
21 16
8 (16) 9 18)
13 (7) 7 (4)
0.042 0.0009
Types of isolates Blood cultures/catheter tips Eye swabs Umbilical swabs Others
31 28 91 14
(35) (20) (22) (24)
14 (7) 18 (9) 80 (41) 2 (1)
0.0001 0.048 0.028 0.0001
Aetiology Klebsiella /Enterobacter spp. H. influenzae
111 4
35 (71) 3 (6)
76 (39) 1 (1)
0.0001 0.025
Diagnostic indicators PCT Leukocyte/30 000 Septic score/two points
17 9 19
9 (18) 6 (12) 12 (24)
8 (4) 3 (2) 7 (4)
0.0016 0.002 0.0001
Localization of infection site Bacteraemia/Sepsis
25
15 (31)
10 (5)
0.0001
Therapy Netilmicin Gentamicı´n Penicillin AMP/cloxacilin Meropenem Ceftazidine Ceftriaxone Cefotaxime Vancomycin
41 80 35 17 11 2 26 9 3
16 (33) 28 (57) 13 (27) 0 (0) 9 (18) 2 (4) 13 (27) 6 (12) 2 (4)
25 (13) 52 (26) 22 (11) 17 (9) 2 (1) 0 (0) 13 (7) 3 (2) 1 (1)
0.0016 0.0001 0.01 0.028 0.0001 0.039 0.0001 0.002 NS
239 3 2 7
44 (90) 3 (6) 2 (4) 5 (10)
195 (99) 0 (0) 0 (0) 2 (1)
0.0039 0.0075 0.039 0.0039
Outcome Cure Death from underlying disease PVL IVH (III/IV)
17 10 11 12
/32 weeks (%)
P
Letter Infection in premature neonates is not associated with higher attributable mortality, but with more neurologic sequellae Sir Premature neonates of less than 32 weeks gestation are at high risk for infection [1,2]. We investigated risk factors and outcome of 49 such neonates compared with 197 neonates with longer gestation in a national neonatal clinic in the Slovak Republic over 2-year period. The Table 1 shows a univariate analysis, to assess risk factors for infection in neonates born before 32 weeks gestation (49) versus infection in neonates born after 32 weeks of gestation (197). The use of medical technology, e.g. ventilator support, total parenteral nutrition, percutaneous arterial catheter, and respiratory distress syndrome were significantly more often observed in more premature neonates (B/32 week of gestation) (P 5/0.02, 0.0001, 0.006 and 0.0001). Prolonged rupture of membranes and cerclage were the risk factors from the mother (P 5/0.042 and 0.0009) associated with shorter gestation as well as bacteraemia (P 5/0.0001). Premature infants of B/32 weeks gestation also showed significantly higher infection rates with Klebsiella /Enterobacter spp. (71.43 vs. 38.58%, P 5/0.0001) than premature new-borns of longer gestation. H. influenzae (P 5/0.025) was more common in new-borns of greater than 32 weeks gestation. Diagnostic markers of sepsis e.g. procalcitonin, leukocytes /30 000, and septic score /two points were more frequently observed in new-borns with less than 32 weeks gestation (P 5/0.001, 0.002, and 0.0001). Death from infection (attributable mortality) was similar in both groups, probably because of early empirical therapy with broad-spectrum antibiotics, which were significantly more frequently used in neonates of shorter gestation. Empirical therapy with broad spectrum cephalosporins or carbapenems helps to maintain similar mortality figures from infection in this
high risk group and more mature neonates with less risk factors for infection. The outcome was better among premature new-borns of /32 weeks (98.98 vs. 89.8%, P 5/0.0039) than those of lesser gestation. Death from underlying disease (P 5/0.0075) neurological sequellae of infection, such as brain abscess (P 5/0.039) and intraventricular haemorrhage (P 5/0.0039), were significantly related to prematurity in neonates. A higher rate of meningitis was not seen in this group of neonates.
References [1] Huttova M. Infection diseases in Neonates. University of Trnava, editor. 2001. p. 255. [2] Krcmery V, Paradisi F, et al. Nosocomial bacterial and fungal meningitis in children, an eight year national survey reporting 101 cases. International Journal of Antimicrobial Agents 2000;15:143 / 7.
B.M. Hafed, E. Bilikova, G. Kovacicova, J. Koprnova, V. Krcmery School of Public Health, University of Trnava, Heydukova 10, 812 50 Bratislava, Slovak Republic E-mail address: [email protected] D. Chovancova, M. Drobna, M. Huttova Postgraduate Medicine School, Neonatal Clinic, Heydukova 10, 812 50 Bratislava, Slovak Republic
0924-8579/02/$30 # 2002 Elsevier Science B.V. and the International Society of Chemotherapy. All rights reserved. doi:10.1016/S0924-8579(02)00346-1
Letter to the Editor
293
Table 1 Infections in neonates born before 32 gestational weeks versus neonates born at or after 32 weeks gestation Gestation weeks
Total
B/32 weeks (%)
Baby’s risk factors Umbilical catheters Ventilatory support Total parenteral nurtirion Percutaneous arterial catheter Respiratory diseases
112 37 30 5 11
29 (59) 13 (27) 18 (37) 4 (8) 8 (16)
83 (42) 24 (12) 12 (6) 1 (0) 3 (2)
0.047 0.02 0.0001 0.006 0.0001
Mother’s risk factors Premature rupture of membrane Cerclage
21 16
8 (16) 9 18)
13 (7) 7 (4)
0.042 0.0009
Types of isolates Blood cultures/catheter tips Eye swabs Umbilical swabs Others
31 28 91 14
(35) (20) (22) (24)
14 (7) 18 (9) 80 (41) 2 (1)
0.0001 0.048 0.028 0.0001
Aetiology Klebsiella /Enterobacter spp. H. influenzae
111 4
35 (71) 3 (6)
76 (39) 1 (1)
0.0001 0.025
Diagnostic indicators PCT Leukocyte/30 000 Septic score/two points
17 9 19
9 (18) 6 (12) 12 (24)
8 (4) 3 (2) 7 (4)
0.0016 0.002 0.0001
Localization of infection site Bacteraemia/Sepsis
25
15 (31)
10 (5)
0.0001
Therapy Netilmicin Gentamicı´n Penicillin AMP/cloxacilin Meropenem Ceftazidine Ceftriaxone Cefotaxime Vancomycin
41 80 35 17 11 2 26 9 3
16 (33) 28 (57) 13 (27) 0 (0) 9 (18) 2 (4) 13 (27) 6 (12) 2 (4)
25 (13) 52 (26) 22 (11) 17 (9) 2 (1) 0 (0) 13 (7) 3 (2) 1 (1)
0.0016 0.0001 0.01 0.028 0.0001 0.039 0.0001 0.002 NS
239 3 2 7
44 (90) 3 (6) 2 (4) 5 (10)
195 (99) 0 (0) 0 (0) 2 (1)
0.0039 0.0075 0.039 0.0039
Outcome Cure Death from underlying disease PVL IVH (III/IV)
17 10 11 12
/32 weeks (%)
P