Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Mortality Following Blood Culture in Premature Infants: Increased with Gram-negative Bacteremia and Candidemia, but Not Gram-positive Bacteremia

Journal of Perinatology volume 24, pages 175–180 (2004)Cite this article

Abstract

OBJECTIVE: To describe survival following nosocomial bloodstream infections and quantify excess mortality associated with positive blood culture.

STUDY DESIGN: Multicenter cohort study of premature infants.

RESULTS: First blood culture was negative for 4648/5497 (78%) of the neonates — 390/4648 (8%) died prior to discharge. Mortality prior to discharge was 19% in the 161 infants with Gram-negative rod (GNR) bacteremia, 8% in the 854 neonates with coagulase negative staphylococcus (CONS), 6% in the 169 infants infected with other Gram-positive bacteria (GP-o), and 26% in the 115 neonates with candidemia. The excess 7-day mortality was 0% for Gram-positive organisms and 83% for GNR bacteremia and candidemia. Using negative blood culture as referent, GNR [hazard ratio (HR)=2.61] and candidemia (HR=2.27) were associated with increased mortality; CONS (HR=1.08) and GP-o (HR=0.97) were not.

CONCLUSIONS: Nosocomial GNR bacteremia and candidemia were associated with increased mortality but Gram-positive bacteremia was not.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Chapman RL, Faix RG . Persistent bacteremia and outcome in late onset infection among infants in a neonatal intensive care unit. Pediatr Infect Dis J 2003;22:17–21.

    Article  Google Scholar 

  2. Hemming VG, Overall Jr JC, Britt MR . Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med 1976;294:1310–1316.

    Article  CAS  Google Scholar 

  3. Leibovitz E, Flidel-Rimon O, Juster-Reicher A, et al. Sepsis at a neonatal intensive care unit: a four-year retrospective study (1989–1992). Isr J Med Sci 1997;33:734–738.

    CAS  PubMed  Google Scholar 

  4. Karlowicz MG, Buescher ES, Surka AE . Fulminant late-onset sepsis in a neonatal intensive care unit, 1988–1997, and the impact of avoiding empiric vancomycin therapy. Pediatrics 2000;106:1387–1390.

    Article  CAS  Google Scholar 

  5. Stoll BJ, Holman RC, Schuchat A . Decline in sepsis-associated neonatal and infant deaths in the United States, 1979 through 1994. Pediatrics 1998;102:e18.

    Article  CAS  Google Scholar 

  6. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.

    Article  Google Scholar 

  7. Thorp JA, Jones PG, Peabody PL, Knox E, Clark RH . Effect of antenatal and postnatal corticosteroid therapy on weight gain and head circumference growth in the nursery. Obstet Gynecol 2002;99:109–115.

    CAS  PubMed  Google Scholar 

  8. Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA . Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population. Is there an epidemic? JAMA 1987;258:2548–2552.

    Article  CAS  Google Scholar 

  9. Stevenson DK, Verter J, Fanaroff AA, et al. Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Arch Dis Child Fetal Neonat Ed 2000, 83–F182.

  10. Malaysian Very Low Birth Weight Study Group. A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units. J Paediatr Child Health 1997;33:18–25.

  11. Baker CJ, Melish ME, Hall RT, et al. Intravenous immune globulin for the prevention of nosocomial infection in low-birth-weight neonates. N Engl J Med 1992;327:213.

    Article  CAS  Google Scholar 

  12. Fanaroff AA, Korones SB, Wright LL, et al. A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infants. N Engl J Med 1994;330:1107.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

In addition to the authors, the following physicians participated by providing data to the administrative data set: Albuquerque, NM, R. Nederhoff, S. Swetnam; Alexandria, VA, L. Goldberg; Augusta, GA, A. Blalock; Austin, TX, J. Courtney, D. Wermer, J. Scharnberg; Baltimore, MD, T. O’Brien; Boca Raton, FL, H. Brenker; Boynton Beach, FL, A. Pena; Caguas, PR, E. Ochoa-Bacallao; Charleston, WV, S. Maxwell; Chattanooga, TN, V. Thomas; Chesterfield, MO, W. Chao; Cheverly, MD, A. Fomufod; Colorado Springs, CO, D. Rommes; Columbia, SC, S. Ellis; Coral Springs, FL, J. Colindres; Coto Laurel, PR, J. Rodriguez; Dallas, TX, J. Whitfield, T. Brannon; Dayton, OH, N. Kantor, M. Belcastro; Denver, CO, D. Eichorst, J. Toney, M. Brown; Elmira, NY, R. Sanders; El Paso, TX, L. Ayo, R. Caviglia, E. Ponte; Englewood, CO, K. Zarlengo; Fort Lauderdale, FL, E. Otero; Fort Worth, TX, M. Stevener, K. Smith, D. Turbeville; Fountain Valley, CA, V. Chundu; Fredericksburg, VA, J. Amin; Greenville, SC, D. Wells, R. Newell; Harrisburg, PA, M. Donahue; Hato Rey, PR, A. Rivera, R. Montanez-Ramos; Houston, TX, R. Rivas, H. Pierantoni, E. O’Donnell; Kansas City, MO, J. Callenbach; Laguna Hills, CA, R. Naglie; Las Vegas, NV, P. Vaughn; Lubbock, TX, F. Perez-Benavides Mayaguez, PR, E. Sanchez; Melbourne, FL, J. Vallette; Newport Beach, CA, L. Wickham, B. Hannam; Ogden, UT, J. Berger; Oklahoma City, OK, S. Lopez, J. Pineda; Pasadena, CA, R. Liberman; Pensacola, FL, P. Berger; Phoenix, AZ, J. Martin, K. Meredith, R. Turbow; Ponce, PR, E. Ochoa, R. Rodriguez; Reno, NV, G. Yup; Riverside, CA, M. Leitner; Roanoke, VA, R. Allen; Rock Hill, SC, A. Payne; San Jose, CA, E. Alderete; San Juan, PR, M. Ortega; San Luis Obispo, CA, S. VanScoy; Santurce, PR, F. Caceres; Seattle, WA, J. Prueitt, T. Sweeney, South Bend, IN, R. White; Spartanburg, SC, V. Iskersky; St. Louis, MO, J. Brenner, M. Maurer; Stratford, NJ, J. Coleman; Tacoma, WA, J. Mulligan, G. Jordan, R. Knudson; Tarzana, CA, J. Banks; Trenton, NJ, R.Axelrod; Tucson, AZ, C. Flores, P. James; Utica, NY, M. Siriwardena; Ventura, CA, J. van Houten; Virginia Beach, VA, E. Bollerup; West Covina, CA, G. Martin; West Palm Beach, FL, D. Kanter; Wichita, KS, B. Bloom; Winter Haven, FL, M. Kong; Yakima, WA, R. Skarin.

Author information

Author notes

  1. Daniel K Benjamin: Dr. Benjamin received support from NIH Grant R03HD42940-01.

Authors and Affiliations

  1. Duke Clinical Research Institute, Durham, NC, USA

    Daniel K Benjamin MD, MPH, PhD & Elizabeth DeLong PhD

  2. Duke University Department of Pediatrics, Durham, NC, USA

    Daniel K Benjamin MD, MPH, PhD, Charles M Cotten MD, Harmony P Garges MD & William J Steinbach MD

  3. Pediatrix Medical Group, Inc., Sunrise, FL, USA

    Reese H Clark MD

Authors
  1. Daniel K Benjamin MD, MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth DeLong PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles M Cotten MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harmony P Garges MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William J Steinbach MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reese H Clark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Benjamin, D., DeLong, E., Cotten, C. et al. Mortality Following Blood Culture in Premature Infants: Increased with Gram-negative Bacteremia and Candidemia, but Not Gram-positive Bacteremia. J Perinatol 24, 175–180 (2004). https://doi.org/10.1038/sj.jp.7211068

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211068

This article is cited by

Search

Advanced search

Quick links