Rising Gram-Negative Neonatal Sepsis (2014-2024)
Publication Title: Neonatal Sepsis from 2014 to 2024: The Resurgence of Gram-Negative Rods
Summary
- Question
This study examined the incidence, pathogens, clinical characteristics, and outcomes of neonatal sepsis—a life-threatening bloodstream infection in newborns—over an 11-year period (2014–2024) in a level IV neonatal intensive care unit (NICU). The researchers compared the findings to data from a prior decade (2004–2013) and historical trends since 1928.
- Why it Matters
- Neonatal sepsis remains a leading cause of illness and death in newborns, particularly those born prematurely or with low birth weight. Understanding changes in pathogen patterns, disease severity, and outcomes is critical for guiding infection prevention strategies, improving neonatal care, and reducing mortality. This research provides insights into evolving trends, such as the increasing prevalence of gram-negative bacteria, which may influence future clinical and public health interventions.
- Methods
- The study used a retrospective cohort design, analyzing data from 233 infants who experienced 250 episodes of sepsis in a NICU between 2014 and 2024. Researchers identified bloodstream infections through blood culture results and clinical criteria, dividing cases into early-onset sepsis (EOS, occurring within 3 days of birth) and late-onset sepsis (LOS, occurring after 3 days). Findings were compared to the 2004–2013 period and historical data spanning decades.
- Key Findings
Gram-negative bacteria, particularly Escherichia coli (E. coli), became an increasingly common cause of neonatal sepsis. For EOS, gram-negative cases rose from 51% to 67%, with a 173% increase in E. coli infections among late preterm and term infants. LOS-related sepsis also showed a higher prevalence of gram-negative bacteria, increasing from 32% (2014–2019) to 50% (2020–2024). Despite a decline in overall LOS rates, mortality linked to LOS more than doubled from 11% to 25%, driven by factors such as lower birth weight, baseline severity of illness, and concurrent conditions like necrotizing enterocolitis (a severe intestinal disease in preterm infants).
- Implications
The findings highlight a troubling rise in gram-negative sepsis, particularly E. coli, which is now the predominant pathogen associated with EOS in both preterm and full-term infants. The increased severity of illness and higher mortality rates underscore the need for enhanced infection prevention strategies, better maternal and neonatal care practices, and re-evaluation of antibiotic use during pregnancy and neonatal care.
- Next Steps
The researchers recommended further investigation into maternal and neonatal colonization by gram-negative bacteria, genomic surveillance of E. coli strains, and improved preventive strategies. They also emphasized the potential need for updated empiric antibiotic regimens and continued efforts to reduce disease severity and improve outcomes in high-risk newborns.
- Funding Information
- This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Yale University also provided funding and support for this research.
Full Citation
Authors
Noa Fleiss, MD, MPH
First AuthorAssociate Professor of Pediatrics
Matthew Bizzarro, MD, FAAP
Last AuthorProfessor of Pediatrics (Neonatal-Perinatal Medicine)