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Abstract：
BACKGROUND: Late-onset neonatal sepsis (LOS) is common in preterm neonates, with increasing incidence in recent years. In the present study, we examined the epidemiology, clinical presentation, and complications of LOS in Cyprus and quantified possible risk factors for the development of this condition.
METHODS: The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as \"Confirmed LOS\": positive blood culture - microorganism isolated and LOS symptoms, \"Unconfirmed LOS\": negative blood culture and LOS symptoms, and \"Controls\" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression.
RESULTS: A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as \"Confirmed LOS\", and \"unconfirmed LOS\" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25).
CONCLUSIONS: The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended.
METHODS: The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as \"Confirmed LOS\": positive blood culture - microorganism isolated and LOS symptoms, \"Unconfirmed LOS\": negative blood culture and LOS symptoms, and \"Controls\" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression.
RESULTS: A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as \"Confirmed LOS\", and \"unconfirmed LOS\" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25).
CONCLUSIONS: The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended.
摘要：
背景：晚发性新生儿败血症（LOS）在早产儿中很常见，近年来发病率不断上升。在本研究中,我们检查了流行病学，临床表现,以及塞浦路斯LOS的并发症，并量化了这种情况发展的可能风险因素。
方法：研究对象是马卡里奥斯三世大主教医院新生儿重症监护病房（NICU）收治的早产儿，塞浦路斯唯一的新生儿三级中心。一个潜在的，设计了病例对照研究，并在2017年4月至2018年10月之间进行。根据血培养结果,早产新生儿被归类为“确认的LOS”：阳性血培养-微生物分离和LOS症状，“未确认的LOS”：血培养阴性和LOS症状，和“对照组”组：血培养阴性，无LOS症状。进行了3组之间的比较和人口统计学之间的关联，使用单变量和多变量逻辑回归评估了临床和治疗特征以及LOS的可能性.
结果：共350例早产儿纳入研究，LOS发生率为41.1%。79例（22.6%）和65例（18.6%）新生儿被归类为“确认LOS”，和“未确认的LOS”病例分别为206例（58.9%）作为对照。确诊的LOS率从中度至晚期早产儿的12.2％到极度早产儿的78.6％不等。在多变量模型中，我们证明了LOS与住院时间之间的独立关联（OR：1.06，95CI：1.01-1.10），通气时间（OR：1.23，95CI：1.07-1.43）和坏死性小肠结肠炎（OR：3.41，95CI：1.13-10.25）。
结论：本研究强调了塞浦路斯早产儿LOS的流行病学及其与通气时间和住院时间以及与坏死性小肠结肠炎的关系。建议建立预防NICU住院期间医院感染和早产儿机械通气的方案。
方法：研究对象是马卡里奥斯三世大主教医院新生儿重症监护病房（NICU）收治的早产儿，塞浦路斯唯一的新生儿三级中心。一个潜在的，设计了病例对照研究，并在2017年4月至2018年10月之间进行。根据血培养结果,早产新生儿被归类为“确认的LOS”：阳性血培养-微生物分离和LOS症状，“未确认的LOS”：血培养阴性和LOS症状，和“对照组”组：血培养阴性，无LOS症状。进行了3组之间的比较和人口统计学之间的关联，使用单变量和多变量逻辑回归评估了临床和治疗特征以及LOS的可能性.
结果：共350例早产儿纳入研究，LOS发生率为41.1%。79例（22.6%）和65例（18.6%）新生儿被归类为“确认LOS”，和“未确认的LOS”病例分别为206例（58.9%）作为对照。确诊的LOS率从中度至晚期早产儿的12.2％到极度早产儿的78.6％不等。在多变量模型中，我们证明了LOS与住院时间之间的独立关联（OR：1.06，95CI：1.01-1.10），通气时间（OR：1.23，95CI：1.07-1.43）和坏死性小肠结肠炎（OR：3.41，95CI：1.13-10.25）。
结论：本研究强调了塞浦路斯早产儿LOS的流行病学及其与通气时间和住院时间以及与坏死性小肠结肠炎的关系。建议建立预防NICU住院期间医院感染和早产儿机械通气的方案。
