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Late-onset Bloodstream Infections in Hospitalized Term Infants

Testoni, Daniela MD, MHS*†; Hayashi, Madoka MD*‡; Cohen-Wolkowiez, Michael MD, PhD*‡; Benjamin, Daniel K. Jr. MD, PhD, MPH*‡; Lopes, Renato D. MD, PhD, MHS*‡; Clark, Reese H. MD§; Benjamin, Daniel K. PhD; Smith, P. Brian MD, MPH, MHS*‡

The Pediatric Infectious Disease Journal: September 2014 - Volume 33 - Issue 9 - p 920–923
doi: 10.1097/INF.0000000000000322
Original Studies

Background: The epidemiology and incidence of late-onset blood stream infections (BSIs) in premature infants have been described, but studies describing late-onset BSI in term infants are sparse. We sought to describe the pathogens, incidence, risk factors and mortality of late-onset BSI in hospitalized term infants.

Methods: A cohort study was conducted of infants ≥37 weeks gestational age and ≤120 days of age discharged from Pediatrix Medical Group neonatal intensive care units from 1997 to 2010. We examined all cultures obtained from day of life 4–120 and used multivariable regression to assess risk factors for late-onset BSI.

Results: We found a total of 206,019 infants cared for between day of life 4 and 120, and the incidence of late-onset BSI was 2.7/1000 admissions. We identified Gram-positive organisms in 64% of the cultures and Gram-negative organisms in 26%. We found a decreased risk of late-onset BSI in infants with the following characteristics: small for gestational age, delivery by Cesarean, antenatal antibiotic use and discharged in the later years of the study. Late-onset BSI increased the risk of death after controlling for confounders [odds ratio 8.43 (95% confidence interval 4.42–16.07)].

Conclusion: Our data highlight the importance of late-onset BSI in hospitalized term infants. We identified Gram-positive organisms as the most common pathogen, and late-onset BSI was an independent risk factor for death.

From the *Duke Clinical Research Institute, Durham, NC; Division of Neonatal Medicine, Escola Paulista de Medicina—Universidade Federal de São Paulo, São Paulo, Brazil; Department of Pediatrics, Duke University, Durham, NC; §Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL; and Department of Economics, Clemson University, Clemson, SC.

Accepted for publication February 25, 2014.

This work was supported by the American Recovery and Reinvestment Act, DHHS-1R18AE000028-01; P.B.S. Dr. Benjamin receives support from the US government for his work in pediatric and neonatal clinical pharmacology (1R01HD057956-05, 1K24HD058735-05, UL1TR001117 and NICHD contract HHSN275201000003I) and the nonprofit organization Thrasher Research Fund for his work in neonatal candidiasis (; he also receives research support from industry for neonatal and pediatric drug development ( Dr. Smith receives salary support for research from the National Institutes of Health (NIH), the US Department of Health and Human Services and the National Center for Advancing Translational Sciences of the NIH (DHHS-1R18AE000028-01, HHSN267200700051C, HHSN275201000003I and UL1TR001117); he also receives research support from industry for neonatal and pediatric drug development ( Dr. Cohen-Wolkowiez receives support for research from the NIH (1K23HD064814), the National Center for Advancing Translational Sciences of the NIH (UL1TR001117), the Food and Drug Administration (1U01FD004858-01), the Biomedical Advanced Research and Development Authority (HHSO100201300009C), the nonprofit organization Thrasher Research Fund ( and from industry for drug development in adults and children (

Funding agencies had no role in any of the following: the design and conduct of the study; collection, management, analysis and interpretation of the data and preparation, review or approval of the manuscript.

The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: P. Brian Smith, MD, MPH, MHS, Duke Clinical Research Institute, Box 17969, Durham, NC 27715. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.