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Epidemiology of Serious Bacterial Infections in Infants Less Than 90 Days in a Military Health System Cohort

Ramchandar, Nanda MD, MPH*; Gierhart, Sarah MS; Creppage, Kathleen E MPH, DrPH; Chukwuma, Uzo MPH; Gerber, Jeffrey S. MD, PhD; Arnold, John MD§; Milder, Edmund MD, MSCE§

The Pediatric Infectious Disease Journal: August 2019 - Volume 38 - Issue 8 - p 849–853
doi: 10.1097/INF.0000000000002346
Maternal-Neonatal Reports

Background: Management of suspected serious bacterial infections (SBIs) in infants less than 3 months old is challenging. Understanding the epidemiology of SBI is necessary to inform management decisions. Recent publications have challenged the previously accepted distribution of infections by specimen source and pathogen. We sought to describe the burden of SBIs in previously healthy infants less than 90 days old.

Methods: We conducted a retrospective analysis of the Military Health System database to identify SBI cases among term infants less than 90 days of age from 2005 to 2015. We defined an SBI case as any previously healthy infant with positive cultures for a likely pathogen from blood, urine or cerebrospinal fluid.

Results: Of 467,462 live births between January 2005 and September 2015, 3421 infants had positive cultures. After excluding 1781 episodes with isolates considered nonpathogenic or ICD-9 codes for chronic conditions, the overall incidence of SBI was 3.1 cases/1000 live births. The SBI rate dropped from 5.0 cases/1000 live births in 2005 to 2.0 cases/1000 live births in 2015 (P < 0.001 for trend). The most common pathogen was Escherichia coli (51.3%).

Conclusions: In this retrospective review of 467,462 live births, the incidence of SBI decreased from 5.0/1000 to 2.0/1000 live births over time. We identified no cases of Listeria monocytogenes. These data can help inform decisions related to treatment and management of infants with suspected bacterial infections.

From the *Department of Pediatrics, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA

Navy and Marine Corps Public Health Center, Portsmouth, Virginia, USA

Children’s Hospital Philadelphia, Philadelphia, Pennsylvania, USA

§Pediatric Infectious Disease, Naval Medical Center San Diego, San Diego, California, USA.

Accepted for publication March 15, 2019.

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

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Address for correspondence: Nanda Ramchandar, MD, MPH, Department of Pediatrics, Naval Hospital Camp Pendleton, Box 555191, Camp Pendleton, CA 92055–5191. E-mail:

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