Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study.

Autor: Auriti C; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy. Electronic address: cinzia.auriti@gmail.com., De Rose DU; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy; University of Rome 'Tor Vergata', Rome, Italy., Santisi A; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Martini L; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Ronchetti MP; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Ravà L; Clinical Epidemiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Antenucci V; Contract Research Organization, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Bernaschi P; Microbiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Serafini L; Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy., Catarzi S; Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy., Fiorini P; Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy., Betta P; Neonatal Intensive Care Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy., Scuderi MG; Pediatric Surgery Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy., Di Benedetto V; Pediatric Surgery Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy., Ferrari S; Department of Neonatology, 'Giovanni XXIII' Hospital, Bergamo, Italy., Maino M; Department of Neonatology, 'Giovanni XXIII' Hospital, Bergamo, Italy., Cavigioli F; Neonatology Unit, Ospedale Dei Bambini 'Vittore Buzzi', ASST FBF-Sacco-Buzzi, Milan, Italy., Cocchi I; Neonatology Unit, Ospedale Dei Bambini 'Vittore Buzzi', ASST FBF-Sacco-Buzzi, Milan, Italy., Giuffré M; Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy., Bonanno E; Neonatology Unit, Azienda Ospedaliera 'SS. Annunziata', Cosenza, Italy., Tzialla C; Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Bua J; Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy., Pugni L; Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Della Torre B; Neonatal Intensive Care Unit, Azienda Ospedaliera S. Maria Della Misericordia, Perugia, Italy., Nardella G; Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti', Foggia, Italy., Mazzeo D; Neonatology Unit, Policlinico 'Gaetano Martino', Messina, Italy., Manzoni P; Dipartimento Materno-Infantile, Ospedale Universitario 'Degli Infermi' di Ponderano, Biella, Italy, University of Torino School of Medicine, Turin, Italy., Capolupo I; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Ciofi Degli Atti M; Clinical Epidemiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Dotta A; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Stronati M; Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Raponi M; Health Directorate, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy., Mosca F; Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Bagolan P; Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2022 Dec; Vol. 130, pp. 122-130. Date of Electronic Publication: 2022 Oct 04.
DOI: 10.1016/j.jhin.2022.09.018
Abstrakt: Background: Limited data are currently available on the incidence rates and risk factors for bacterial sepsis and invasive fungal infections (IFIs) among neonates and infants undergoing major surgery.
Aim: To assess the incidence of bacterial sepsis and IFI, fungal colonization, risk factors for sepsis, and mortality in neonates and infants aged <3 months undergoing major surgery.
Methods: A multicentre prospective study was conducted involving 13 level-3 neonatal intensive care units in Italy, enrolling all infants aged ≤3 months undergoing major surgery.
Findings: From 2018 to 2021, 541 patients were enrolled. During hospitalization, 248 patients had a bacterial infection, and 23 patients had a fungal infection. Eighty-four patients were colonized by fungal strains. Overall, in-hospital mortality was 2.8%, but this was higher in infected than in uninfected infants (P = 0.034). In multivariate analysis, antibiotic exposure before surgery, ultrasound-guided or surgical placement of vascular catheters, vascular catheterization duration, and gestational age ≤28 weeks were all associated with bacterial sepsis. The risk of IFI was markedly higher in colonized infants (odds ratio (OR): 8.20; P < 0.001) and was linearly associated with the duration of vascular catheterization. Fungal colonization in infants with abdominal surgery increased the probability of IFI 11-fold (OR: 11.1; P < 0.001).
Conclusion: Preventive strategies such as early removal of vascular catheters and the fluconazole prophylaxis should be considered to prevent bacterial and fungal sepsis in infants undergoing abdominal surgery, and even more so in those with fungal colonization.
(Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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