PT  - JOURNAL ARTICLE
AU  - Wang, Joanna
AU  - Kortsalioudaki, Christina
AU  - Heath, Paul T
AU  - Buttery, Jim
AU  - Clarke, Paul
AU  - Gkentzi, Despoina
AU  - Anthony, Mark
AU  - Tan, Kenneth
ED  - ,
TI  - Epidemiology and healthcare factors associated with neonatal enterococcal infections
AID  - 10.1136/archdischild-2018-315387
DP  - 2019 Sep 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F480--F485
VI  - 104
IP  - 5
4099  - http://fn.bmj.com/content/104/5/F480.short
4100  - http://fn.bmj.com/content/104/5/F480.full
SO  - Arch Dis Child Fetal Neonatal Ed2019 Sep 01; 104
AB  - Objective To investigate the epidemiology and healthcare factors associated with late-onset neonatal enterococcal infections.Design Multicentre, multinational retrospective cohort study using prospectively collected infection data from a neonatal infection surveillance network between 2004 and 2016; this was supplemented with healthcare data from a questionnaire distributed to participating neonatal units.Setting Sixty neonatal units across Europe (UK, Greece, Estonia) and Australia.Patients Infants admitted to participating neonatal units who had a positive culture of blood, cerebrospinal fluid or urine after 48 hours of life.Results In total, 414 episodes of invasive Enterococcus spp infection were reported in 388 infants (10.1% of a total 4083 episodes in 3602 infants). Enterococcus spp were the second most common cause of late-onset infection after coagulase-negative Staphylococcus spp and were strongly associated with necrotising enterocolitis (NEC) (adjusted OR 1.44, 95% CI 1.02 to 2.03, p=0.038), total parenteral nutrition (TPN) (adjusted OR 1.34, 95% CI 1.06 to 1.70, p=0.016), increasing postnatal age (per 1-week increase: adjusted OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and decreasing birth weight (per 1 kg increase: adjusted OR 0.85, 95% CI 0.74 to 0.97, p=0.017). There was no evidence that inadequate nurse to patient staffing ratios in high-dependency units were associated with a higher risk of enterococcal infections.Conclusions Enterococcus spp were the second most frequent cause of late-onset infections. The association between enterococcal infections, NEC and TPN may inform empiric antimicrobial regimens in these contexts and provide insights into reducing these infections.