Objective To describe the epidemiology of neonatal infection over the past decade in UK neonatal units.
Design Retrospective analysis of prospectively collected infection surveillance network data from 2005 to 2014.
Setting 30 neonatal units in the UK.
Patients Newborns on participating neonatal units who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of appropriate antibiotics.
Results 2171 episodes of neonatal infection in 1922 infants were recorded. The incidence of infection was 6.1/1000 live births and 48.8/1000 neonatal admissions (2.9 and 23.5 respectively if coagulase-negative staphylococci (CoNS) cultures excluded). The incidence of infection showed a statistically significant reduction over time with reductions in the rates of both early-onset sepsis (EOS) and late-onset sepsis (LOS).
The majority of episodes (76%) represented LOS (diagnosed > 48 hours after birth), and infection was more common in premature (<37 weeks gestation) and low birth weight (<2500 g) neonates (84% and 81%, respectively). Commonly identified pathogens included group B streptococci (43%) and Escherichia coli (18%) for EOS, while E. coli (15%), Staphylococcus aureus (14%) and CoNS were prominent causes of LOS.
Conclusions This paper describes the epidemiology of neonatal infection in the UK over the past decade. These data enable benchmarking of practice and inform areas of future research and guideline development. The results support the hypothesis that the introduction of infection prevention care bundles and antibiotic stewardship programmes in the UK has reduced the burden of LOS.
- infectious diseases
- intensive care
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Contributors BC and CK contributed to the design of the analysis, conducted the analysis of the data, drafted the manuscript and revised it according to feedback from co-authors. PH developed the neonIN network, designed the current analysis and provided critical appraisal as well as final approval of the manuscript. JB, SP, AG, JM, AR and NK made substantial contributions to the acquisition of data for the analysis, critically revised the manuscript and provided final approval for the version to be submitted. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests None declared.
Ethics approval The neonIN database received ethics approval from the London-Surrey Borders Research Ethics Committee in April 2005 (05/Q0806/34) and this was extended in December 2013 (05/Q0806/34+5) for a period of 5 years.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data from this study are available only to members of the neonIN team and may form part of future analyses. Generalised statistics however are freely available on the neonIN website at https://www.neonin.org.uk/.
Collaborators neonIN network collaborators: Medaht Ezzat; Marion Bohatschek; Clare Cane; Imogen Storey; Sam Wallis; Ruppa Geethanath; Jonathan Campbell; John Chang; Timothy Watts; Olga Kapellou; Suzanne Luck; Mark Turner; Sakina Ali; Edward Gasiorowski; Mithilesh Lal; Nick Embleton; Paul Clarke; Sajeev Job; Mark Anthony; Tim Scorrer; Shanmuga Sundaram; Andrew Collinson; Nigel Osborne; Mike Hall; Elizabeth Pilling; Leika Hamilton; Gaurav Atreja; Jonathan Davis; Peter Reynolds; Prakash Satodia