Epidemiology and microbiology of late-onset sepsis among preterm infants in China, 2015-2018: A cohort study.

OBJECTIVE: To describe the incidence, case-fatality rate and pathogen distribution of late-onset sepsis (LOS) among preterm infants in China and to investigate risk factors and short-term outcomes associated with LOS caused by Gram-positive bacteria, Gram-negative bacteria and fungi.

METHODS: This cohort study included all infants born at <34 weeks' gestation and admitted to 25 tertiary hospitals from 19 provinces in China from May, 2015 to April, 2018, excluding infants who died or were discharged within 3 days of life.

RESULTS: Totally 1199 episodes of culture-positive LOS were identified in 1133 infants, with an incidence of 4.4% (1133/25725). Overall, 15.4% (175/1133) of infants with LOS died and 10.0% (113/1133) of infants died within 7 days after LOS onset. Among 1214 pathogens isolated, Gram-negative bacteria were the most common pathogens (51.8%, 629/1214). Fungi accounted for 17.1% (207/1214) of pathogens. Use of central lines, longer duration of antibiotics and previous carbapenem exposure were related with increased risk of fungal LOS compared with Gram-positive bacteria. Gram-negative bacteria LOS was independently associated with increased risk of death, periventricular leukomalacia, bronchopulmonary dysplasia and necrotizing enterocolitis. Fungal LOS was independently associated with increased risk of periventricular leukomalacia, bronchopulmonary dysplasia and necrotizing enterocolitis.

CONCLUSIONS: LOS was a significant cause of morbidity and mortality in Chinese NICUs with a distinct pathogen distribution from industrial countries. Clinical guidelines on the prevention and treatment of LOS should be developed and tailored to these LOS characteristics in Chinese NICUs.