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Am J Perinatol 2020; 37(S 02): S71-S75
DOI: 10.1055/s-0040-1714256
Original Article

The Spanish National Network “Grupo Castrillo”: 22 Years of Nationwide Neonatal Infection Surveillance

Belen Fernandez Colomer
1   Division of Neonatology, Department of Pediatrics, Central University Hospital of Asturias, Oviedo, Spain
,
Maria Cernada Badia
2   Neonatal Research Unit, Division of Neonatology, La Fe University Hospital, Valencia, Spain
,
Daniel Coto Cotallo
1   Division of Neonatology, Department of Pediatrics, Central University Hospital of Asturias, Oviedo, Spain
,
Jose Lopez Sastre
1   Division of Neonatology, Department of Pediatrics, Central University Hospital of Asturias, Oviedo, Spain
,
Grupo Castrillo Network › Author Affiliations
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Abstract

Objective This study aimed to describe the epidemiology of vertically transmitted sepsis (VS) and nosocomial sepsis (NOS) in very low birth weight (VLBW) neonates (birth weight ≤ 1,500 g) over the past 22 years in Spain.

Study Design This is a retrospective analysis of prospectively collected VS and NOS in neonates from 1996 to 2018 in the 44 neonatal units integrated in the Spanish Neonatal Network Grupo Castrillo.

Results A total of 2,676 episodes of VS were recorded in 2,196,129 live births (LBs; 1.2/1,000 LBs) over the study period (1996–2018). The incidence declined from 2.4 to 1 to 1.2/1,000 LBs (p < 0.0001). Of the 2,676 episodes, 95.7% were early onset (≤72 hours) and 4.3% cases late onset VS. Group B streptococcus (GBS) (33.1%) and E. coli (29.3%) were the most frequently isolated pathogen. The GBS incidence declined significantly from 1.25 to 0.21/1,000 LBs (p < 0.0001). E. coli incidence showed a significant increase trend in VLBW infants (p < 0.05). The global mortality per 1000 LBs decreased from 0.21 to 0.13/1,000. A total of 7,036 episodes of NOS involving 5,493 VLBW infants were registered over 20,935 neonatal admissions (NAs) in the study period (2006–2018). The incidence was 26.2 per 100 NAs. The median postnatal age at onset was 13 days (interquartile range [IQR]: 9–23 days). Around 80% of cases occurred in infants with a central line in place. Gram positive (GP) bacteria accounted for 66.2% with Staphylococcus epidermidis as the most frequently isolated pathogen, gram negative (GN) bacteria entailed 27.4%, and fungi 6.2%. Klebsiella sp. was the most common GN isolated and Candida albicans the most prevalent fungus. The overall mortality was 8.3%.

Conclusion The causative pathogen of neonatal sepsis may change over time and between countries, therefore a national surveillance network based on a consensus definition could be essential to provide accurate information.

Key Points

  • Grupo Castrillo is a Spanish network for neonatal infections surveillance.

  • A neonatal sepsis definition based on epidemilogical and not only chronological criteria was established.

  • Epidemiology of neonatal sepsis may change over time; therefore, a national surveillance network is essential to provide accurate information.

Keywords

neonatal sepsis - vertical transmission - nosocomial transmission

* See Supplementary Material (available in the online version) for members of the Grupo Castrillo Neonatal Network.




Publication History

Article published online:
08 September 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 López Sastre JB, Coto Cotallo GD, Fernández Colomer B. Grupo de Hospitales Castrillo. Neonatal sepsis of vertical transmission: an epidemiological study from the “Grupo de Hospitales Castrillo”. J Perinat Med 2000; 28 (04) 309-315
    PubMedGoogle Scholar
  • 2 López Sastre JB, Coto Cotallo D, Fernández Colomer B. Grupo de Hospitales Castrillo. Neonatal sepsis of nosocomial origin: an epidemiological study from the “Grupo de Hospitales Castrillo”. J Perinat Med 2002; 30 (02) 149-157
    CrossrefPubMedGoogle Scholar
  • 3 López Sastre JB, Solís DP, Serradilla VR, Colomer BF, Cotallo GD. Grupo de Hospitales Castrillo. Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission. BMC Pediatr 2007; 7: 9
    CrossrefPubMedGoogle Scholar
  • 4 Carbonell-Estrany X, Figueras-Aloy J, Salcedo-Abizanda S, de la Rosa-Fraile M. Castrillo Study Group. Probable early-onset group B streptococcal neonatal sepsis: a serious clinical condition related to intrauterine infection. Arch Dis Child Fetal Neonatal Ed 2008; 93 (02) F85-F89
    CrossrefPubMedGoogle Scholar
  • 5 López Sastre JB, Fernández Colomer B, Coto Cotallo GD, Ramos Aparicio A. Grupo de Hospitales Castrillo. Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention. Acta Paediatr 2005; 94 (04) 451-457
    CrossrefPubMedGoogle Scholar
  • 6 López Sastre JB, Coto Cotallo GD, Fernández Colomer B. Grupo de Hospitales Castrillo. Neonatal invasive candidiasis: a prospective multicenter study of 118 cases. Am J Perinatol 2003; 20 (03) 153-163
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC. Grupo de Hospitales Castrillo. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol 2007; 22 (10) 1735-1741
    CrossrefPubMedGoogle Scholar
  • 8 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100 (03) F257-F263
    CrossrefPubMedGoogle Scholar
  • 9 Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr 2016; 28 (02) 135-140
    CrossrefPubMedGoogle Scholar
  • 10 Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F. Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS. Klin Padiatr 2013; 225 (02) 75-80
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Cailes B, Kortsalioudaki C, Buttery J. , et al; neonIN network. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed 2018; 103 (06) F547-F553
    CrossrefPubMedGoogle Scholar
  • 12 Stoll BJ, Hansen N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol 2003; 27 (04) 293-301
    CrossrefPubMedGoogle Scholar
  • 13 Manzoni P, De Luca D, Stronati M. , et al. Prevention of nosocomial infections in neonatal intensive care units. Am J Perinatol 2013; 30 (02) 81-88
    Article in Thieme ConnectPubMedGoogle Scholar