Which Factors Predict Hospital-Acquired Late-Onset Neonatal Sepsis?

James W. Gray

Disclosures

Pediatr Health. 2008;2(4):477-484. 

In This Article

Value of Predicting Risk Factors for LOS

Nosocomial infection rates on different neonatal units vary widely. There are several reasons for this variation, including differences in the way that sepsis is defined, differences in the types of babies treated and differences in standards of care. There is clear evidence that the contributors to nosocomial infection are indeed multifactorial. Brodie et al. investigated the contribution of different case mixes to the variation in sepsis rates between NICUs in the USA, and concluded that case mix-related risk factors accounted for only some of the variation between units.[6] Leading on from this, it has been shown that participation in multicenter infection surveillance schemes can lead to substantial reductions in nosocomial infection rates in NICUs.[7] The Vermont Oxford Network of NICUs in the USA achieved a reduction in the incidence of bloodstream infections with coagulase-negative staphylococci from 24.6-16.4% by promoting both improved infection prevention and more reliable diagnosis of true bloodstream infection, backed by a multicenter infection surveillance scheme.[8] For such surveillance schemes to provide meaningful comparisons of sepsis rates between units, and even in the same unit over time, stratification for risk factors is required.[9] A multicenter study by Stover et al. found that different NICUs had widely different ways of reporting nosocomial infection rates and, in particular, many did not stratify by even simple and static risk factors, such as birthweight or gestational age.[10] Therefore, it can be concluded that there is as yet no generally accepted means of reporting, or stratifying for, risk factors for nosocomial LOS to support multicenter surveillance schemes that could assist delivery of a greater consistency of care between NICUs.

An understanding of risk factors for LOS can also identify the high-risk aspects of neonatal care that should be the target of infection prevention interventions. Finally, clusters of infection with particular nosocomial pathogens inevitably occur on NICUs from time to time. An understanding of risk factors for acquisition and/or infection with the outbreak strain can inform infection control measures to terminate the outbreak.

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