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

Infant, Newborn Infant Humans Incidence Prospective Studies Mycoses / epidemiology Invasive Fungal Infections / epidemiology Risk Factors Sepsis / epidemiology Antifungal Agents / therapeutic use
Candida Fungal colonization Fungal infection Neonatal sepsis Surgery

Journal

The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166

Informations de publication

Date de publication:
Dec 2022
Historique:
received: 27 07 2022
revised: 13 09 2022
accepted: 15 09 2022
pubmed: 7 10 2022
medline: 16 11 2022
entrez: 6 10 2022
Statut: ppublish

Résumé

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. 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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 OBJECTIVE
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 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 RESULTS
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 CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.jhin.2022.09.018 PMID: 36202186
pubmed: 36202186
pii: S0195-6701(22)00313-9
doi: 10.1016/j.jhin.2022.09.018
pii:
doi:

Substances chimiques

Antifungal Agents 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

122-130

Informations de copyright

Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Auteurs

C 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.

D U 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.

A Santisi (A)

Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

L Martini (L)

Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

M P Ronchetti (MP)

Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

L Ravà (L)

Clinical Epidemiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

V Antenucci (V)

Contract Research Organization, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

P Bernaschi (P)

Microbiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

L Serafini (L)

Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy.

S Catarzi (S)

Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy.

P Fiorini (P)

Neonatal Intensive Care Unit, Department of Critical Care Medicine, Anna Meyer University Children's Hospital, Florence, Italy.

P Betta (P)

Neonatal Intensive Care Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy.

M G Scuderi (MG)

Pediatric Surgery Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy.

V Di Benedetto (V)

Pediatric Surgery Unit, Azienda Ospedaliera-Universitaria 'Policlinico Gaspare Rodolico', Catania, Italy.

S Ferrari (S)

Department of Neonatology, 'Giovanni XXIII' Hospital, Bergamo, Italy.

M Maino (M)

Department of Neonatology, 'Giovanni XXIII' Hospital, Bergamo, Italy.

F Cavigioli (F)

Neonatology Unit, Ospedale Dei Bambini 'Vittore Buzzi', ASST FBF-Sacco-Buzzi, Milan, Italy.

I Cocchi (I)

Neonatology Unit, Ospedale Dei Bambini 'Vittore Buzzi', ASST FBF-Sacco-Buzzi, Milan, Italy.

M Giuffré (M)

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy.

E Bonanno (E)

Neonatology Unit, Azienda Ospedaliera 'SS. Annunziata', Cosenza, Italy.

C Tzialla (C)

Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

J Bua (J)

Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

L Pugni (L)

Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

B Della Torre (B)

Neonatal Intensive Care Unit, Azienda Ospedaliera S. Maria Della Misericordia, Perugia, Italy.

G Nardella (G)

Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti', Foggia, Italy.

D Mazzeo (D)

Neonatology Unit, Policlinico 'Gaetano Martino', Messina, Italy.

P Manzoni (P)

Dipartimento Materno-Infantile, Ospedale Universitario 'Degli Infermi' di Ponderano, Biella, Italy, University of Torino School of Medicine, Turin, Italy.

I Capolupo (I)

Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

M Ciofi Degli Atti (M)

Clinical Epidemiology Unit, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

A Dotta (A)

Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

M Stronati (M)

Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

M Raponi (M)

Health Directorate, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

F Mosca (F)

Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

P Bagolan (P)

Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, 'Bambino Gesù' Children's Hospital IRCCS, Rome, Italy.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Incidence and risk factors of bacterial sepsis...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Incidence and risk factors of bacterial sepsis...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Incidence and risk factors of bacterial sepsis...
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questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Mycoses › Infections fongiques invasives › Incidence and risk factors of bacterial sepsis...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Incidence and risk factors of bacterial sepsis...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antifongiques › Incidence and risk factors of bacterial sepsis...