Late-onset bloodstream infections in hospitalized term infants

Pediatr Infect Dis J. 2014 Sep;33(9):920-3. doi: 10.1097/INF.0000000000000322.


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.

Publication types

  • Research Support, American Recovery and Reinvestment Act
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology*
  • Bacteremia / mortality
  • Cesarean Section
  • Cohort Studies
  • Female
  • Fungemia / epidemiology
  • Fungemia / microbiology
  • Gram-Negative Bacterial Infections / complications
  • Gram-Negative Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / complications
  • Gram-Positive Bacterial Infections / epidemiology*
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Male
  • Mycoses / complications
  • Mycoses / epidemiology
  • Prenatal Care
  • Risk Factors
  • Term Birth
  • Time Factors
  • United States / epidemiology


  • Anti-Bacterial Agents