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

Am J Perinatol. 2020 Sep;37(S 02):S71-S75. doi: 10.1055/s-0040-1714256. Epub 2020 Sep 8.


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..

MeSH terms

  • Birth Weight
  • Candidiasis / epidemiology
  • Catheterization, Central Venous
  • Cross Infection / epidemiology*
  • Escherichia coli Infections / epidemiology
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Infections / transmission
  • Infectious Disease Transmission, Vertical
  • Intensive Care, Neonatal
  • Klebsiella Infections / epidemiology
  • Length of Stay
  • Parenteral Nutrition
  • Pseudomonas Infections / epidemiology
  • Respiration, Artificial
  • Retrospective Studies
  • Risk Factors
  • Sepsis / epidemiology*
  • Sepsis / microbiology
  • Spain / epidemiology
  • Staphylococcal Infections / epidemiology