Neonatal sepsis in Switzerland: A prospective nationwide study

Abstract

Background: Neonatal infection is a major cause of morbidity and mortality. Recent studies have reported an incidence of early-onset neonatal sepsis (EOS) of 0.5-0.9 per 1000 livebirths. Late-onset sepsis (LOS) affects mainly preterm newborns with an incidence of 15-25% in infants born <32 weeks. Objective: To evaluate the epidemiology of blood culture-proven sepsis in newborns in Switzerland. Methods: Newborn infants admitted to the ten Swiss neonatal intensive care units and presenting with blood culture-proven sepsis between 9.2011 and 12.2015 were included. EOS was defined as infection occurring <72h of life. LOS was defined as infection presenting ≥72h of life. In infants with LOS, those presenting with signs of infection before or ≤48h after admission were classified as having community-acquired (CA) LOS, while infants presenting with signs of infection >48h after admission were classified as having hospital-acquired (HA) LOS. Results: We identified 444 episodes of blood culture-proven sepsis in 430 infants; 87 (20%) were EOS and 357 (80%) were LOS. Among episodes of LOS, 278 (62%) were HA-LOS and 79 (18%) were CA-LOS. The incidence of EOS, HA-LOS and CA-LOS was 0.27 (95% CI 0.22-0.33), 0.82 (0.72-0.92) and 0.26 (0.21-0.32) per 1000 livebirths. In infants born <32 weeks, the incidence of EOS, HA-LOS and CA-LOS was 1.0% (95% CI 0.7-1.4), 6.1% (5.3-7.0) and 0.1% (0.03-0.3). Median gestational age at birth was 34 (IQR 29-39), 27 (26-32) and 40 (39-41) weeks for EOS, HA-LOS and CA-LOS. Mortality was 18% (16/87), 12% (33/278) and 0% (0/79) in EOS, HA-LOS and CA-LOS. The proportion of infants that presented with septic shock was 30% (26/87), 19% (53/278) and 3% (2/79) in EOS, HA-LOS and CA-LOS. The most frequently isolated pathogens were Group B Streptococcus (38%, 33/87) and Escherichia coli (23%, 20/87) in EOS, Coagulase-negative Staphylococci (40%, 111/278), Staphylococcus aureus (16%, 44/278) and Escherichia coli (15%, 43/278) in HA-LOS, and Escherichia coli (42%, 33/79) and Group B Streptococcus (39%, 31/79) in CA-LOS. Conclusions: This national study shows a lower incidence of neonatal sepsis in Switzerland compared to recently published studies from other industrialized countries. However, mortality and morbidity of EOS and HA-LOS remains considerable. Among neonatal sepsis, we describe three entities with distinct clinical presentation, pathogens and outcomes.L6270242702019-04-05 <br />