@article {1789, title = {Procalcitonin in detecting neonatal nosocomial sepsis.}, journal = {Arch Dis Child Fetal Neonatal Ed}, year = {2011}, month = {2011 Mar 15}, abstract = {

OBJECTIVE: To investigate the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial sepsis (NS) and define the most accurate cut-off to distinguish infected from uninfected neonates. SETTING: Six neonatal intensive care units (NICUs). PATIENTS: 762 neonates admitted to six NICUs during a 28-month observational study for whom at least one serum sample was taken on admission. MAIN OUTCOME MEASURES: Positive and negative predictive values at different PCT cut-off levels. RESULTS: The overall probability of an NS was doubled or more if PCT was >0.5 ng/ml. In very-low-birth-weight (VLBW) infants, a cut-off of >2.4 ng/ml gave a positive predictive value of NS near to 50\% with a probability of a false-positive diagnosis of NS in about 10\% of the patients. CONCLUSIONS: In VLBW neonates, a serum PCT value >2.4 ng/ml prompts early empirical antibiotic therapy, while in normal-birth-weight infants, a PCT value <=2.4 ng/ml carries a low risk of missing an NS.

}, issn = {1468-2052}, doi = {10.1136/adc.2010.194100}, author = {Auriti, Cinzia and Fiscarelli, Ersilia and Ronchetti, Maria Paola and Argentieri, Marta and Marrocco, Gabriella and Quondamcarlo, Anna and Seganti, Giulio and Bagnoli, Francesco and Buonocore, Giuseppe and Serra, Giovanni and Bacolla, Gianfranco and Mastropasqua, Savino and Mari, Annibale and Corchia, Carlo and Prencipe, Giusi and Piersigilli, Fiammetta and Rav{\`a}, Lucilla and Di Ciommo, Vincenzo} } @article {1617, title = {Determinants of nosocomial infection in 6 neonatal intensive care units: an Italian multicenter prospective cohort study.}, journal = {Infect Control Hosp Epidemiol}, volume = {31}, year = {2010}, month = {2010 Sep}, pages = {926-33}, abstract = {

BACKGROUND: Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs).

OBJECTIVE: To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection.

DESIGN: A multicenter, prospective cohort study.

PATIENTS AND SETTING: A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay.

METHODS: Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated.

RESULTS: A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95\% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95\% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95\% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95\% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95\% CI, 1.5-3.5]).

CONCLUSIONS: Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.

}, keywords = {Bacteremia, Birth Weight, Cross Infection, Gestational Age, Hospitals, University, Humans, Incidence, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Italy, Length of Stay, Proportional Hazards Models, Prospective Studies, Risk Factors, Sepsis, Time Factors}, issn = {1559-6834}, doi = {10.1086/655461}, author = {Auriti, Cinzia and Ronchetti, Maria Paola and Pezzotti, Patrizio and Marrocco, Gabriella and Quondamcarlo, Anna and Seganti, Giulio and Bagnoli, Francesco and De Felice, Claudio and Buonocore, Giuseppe and Arioni, Cesare and Serra, Giovanni and Bacolla, Gianfranco and Corso, Giovanna and Mastropasqua, Savino and Mari, Annibale and Corchia, Carlo and Di Lallo, Domenico and Rav{\`a}, Lucilla and Orzalesi, Marcello and Di Ciommo, Vincenzo} }