A Study on the Incidence and Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

ABSTRACT

PURPOSE: Although advances in neonatal intensive care have led to improved survival of very low birth weight(VLBW) infants, nosocomial sepsis continues to be an important cause of morbidity and death among these infants. Our study was carried out to estimate the incidence of nosocomial sepsis and to identify the attributable risk factors for sepsis. METHODS: The results of blood cultures taken from 182 infants with their birth weights less than 1,500 gram who were admitted to the NICU at Samsung Medical Center from October 1994 to December 1997 were retrospectively reviewed. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. RESULTS: Of 166 infants who survived beyond 3 days, 57(34.3%) had nosocomial sepsis(positive blood culture at age greater than 3 days and antibiotic therapy for more than 5 days). The incidence of nosocomial sepsis was 1.8/100 hospital days and the interval between admission and onset of sepsis was 18.4+17.8 days(meanSD). Coagulase negative staphylococci(35.3%) were the most common organism in nosocomial sepsis. On multiple logistic regression analysis, several risk factors appeared to be independently associated with sepsis. The risk of nosocomial sepsis rose with decreasing gestational age, with increasing ventilator duration, UAC(umbilical venous catheter) duration, PCVC(percutanous central venous catheter) duration, nasal prong duration. And infants with nosocomial sepsis were more likely to be outborn, resuscitated at delivery room and to have bronchopulmonary dysplasia. CONCLUSION: Directing quality improvement efforts toward decreasing exposure to invasive vascular catheter and reducing ventilator days may decrease the incidence of nosocomial sepsis in VLBW infants.