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Postconception Age and Other Risk Factors Associated with Mortality Following Gram-negative Rod Bacteremia

Journal of Perinatology volume 24, pages 169–174 (2004)Cite this article

Abstract

BACKGROUND: Neonatal nosocomial Gram-negative rod bacteremia (GNR-b) is considered ominous.

DESIGN: Multi-center cohort study of premature infants (N=6172) who had a blood culture after day of life 3 and whose birthweight was ≤1250 g.

RESULTS: A total of 437 neonates developed GNR-b; most commonly with Klebsiella (122/437; 28%), Enterobacter (97/437; 22%), Escherichia coli (90/437; 21%), Pseudomonas (63/437; 14%), and Serratia (49/437; 11%). Neonates infected with Pseudomonas were more likely to die (21/63; 33%) than infants infected with other GNR (50/374; 13%). In multivariable logistic regression, infection with Pseudomonas, mechanical ventilation, and race were associated with subsequent mortality. Postconception age (PCA) was most strongly associated with mortality. Using neonates with >34 weeks PCA at the time of the first blood culture as the reference category, mortality was higher in neonates <26 weeks PCA (odds ratio (OR)=9.21; 95% confidence interval (CI)=2.79, 30.44), and in neonates 26 to 28 weeks PCA (OR=3.94; 95% CI=1.29, 12.03).

CONCLUSIONS: Among premature infants, much of the mortality experienced in GNR-b is due to infection with Pseudomonas rather than enteric GNR. Race, the need for mechanical ventilation, and younger PCA when the blood culture was obtained were also strongly associated with mortality.

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Acknowledgements

In addition to the authors, the following physicians participated by providing data to the data set: Albuquerque, NM, R. Nederhoff, S. Swetnam; Alexandria, VA, L. Goldberg; Augusta, GA, A. Blalock; Austin, TX, J. Courtney, D. Wermer, J. Scharnberg; Baltimore, MD, T. O'Brien; Boca Raton, FL, H. Brenker; Boynton Beach, FL, A. Pena; Caguas, PR, E. Ochoa-Bacallao; Charleston, WV, S. Maxwell; Chattanooga, TN, V. Thomas; Chesterfield, MO, W. Chao; Cheverly, MD, A. Fomufod; Colorado Springs, CO, D. Rommes; Columbia, SC, S. Ellis; Coral Springs, FL, J. Colindres; Coto Laurel, PR, J. Rodriguez; Dallas, TX, J. Whitfield, T. Brannon; Dayton, OH, N. Kantor, M. Belcastro; Denver, CO, D. Eichorst, J. Toney, M. Brown; Elmira, NY, R. Sanders; El Paso, TX, L. Ayo, R. Caviglia, E. Ponte; Englewood, CO, K. Zarlengo; Fort Lauderdale, FL, E. Otero; Fort Worth, TX, M. Stevener, K. Smith, D. Turbeville; Fountain Valley, CA, V. Chundu; Fredericksburg, VA, J. Amin; Greenville, SC, D. Wells, R. Newell; Harrisburg, PA, M. Donahue; Hato Rey, PR, A. Rivera, R. Montanez-Ramos; Houston, TX, R. Rivas, H. Pierantoni, E. O'Donnell; Kansas City, MO, J. Callenbach; Laguna Hills, CA, R. Naglie; Las Vegas, NV, P. Vaughn; Lubbock, TX, F. Perez-Benavides Mayaguez, PR, E. Sanchez; Melbourne, FL, J. Vallette; Newport Beach, CA, L. Wickham, B. Hannam; Ogden, UT, J. Berger; Oklahoma City, OK, S. Lopez, J. Pineda; Pasadena, CA, R. Liberman; Pensacola, FL, P. Berger; Phoenix, AZ, J. Martin, K. Meredith, R. Turbow; Ponce, PR, E. Ochoa, R. Rodriguez; Reno, NV, G. Yup; Riverside, CA, M. Leitner; Roanoke, VA, R. Allen; Rock Hill, SC, A. Payne; San Jose, CA, E. Alderete; San Juan, PR, M. Ortega; San Luis Obispo, CA, S. VanScoy; Santurce, PR, F. Caceres; Seattle, WA, J. Prueitt, T. Sweeney, South Bend, IN, R. White; Spartanburg, SC, V. Iskersky; St. Louis, MO, J. Brenner, M. Maurer; Stratford, NJ, J. Coleman; Tacoma, WA, J. Mulligan, G. Jordan, R. Knudson; Tarzana, CA, J. Banks; Trenton, NJ, R.Axelrod; Tucson, AZ, C. Flores, P. James; Utica, NY, M. Siriwardena; Ventura, CA, J. van Houten; Virginia Beach,VA, E. Bollerup; West Covina, CA, G. Martin; West Palm Beach, FL, D. Kanter; Wichita, KS, B. Bloom; Winter Haven, FL, M. Kong; Yakima, WA, R. Skarin.

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  1. Daniel K Benjamin: Dr. Benjamin received support from the National Institute of Child Health and Human Development (NICHD: R03HD42940-01).

Authors and Affiliations

  1. Duke Clinical Research Institute, Durham, NC, USA

    Daniel K Benjamin Jr. MD, MPH, PhD & Elizabeth R DeLong PhD

  2. Duke University Pediatrics, Durham, NC, USA

    Daniel K Benjamin Jr. MD, MPH, PhD, Charles M Cotten MD & Harmony P Garges MD

  3. Pediatrix Medical Group, Inc., Sunrise, FL, USA

    Reese H Clark MD

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Benjamin, D., DeLong, E., Cotten, C. et al. Postconception Age and Other Risk Factors Associated with Mortality Following Gram-negative Rod Bacteremia. J Perinatol 24, 169–174 (2004). https://doi.org/10.1038/sj.jp.7211047

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