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PLoS By Category | Recent PLoS Articles
Critical Care and Emergency Medicine - Pediatrics and Child Health - Public Health and Epidemiology - Infectious Diseases

Epidemic Microclusters of Blood-Culture Proven Sepsis in Very-Low-Birth Weight Infants: Experience of the German Neonatal Network
Published: Friday, June 29, 2012
Author: Christoph Härtel et al.

by Christoph Härtel, Kirstin Faust, Stefan Avenarius, Bettina Bohnhorst, Michael Emeis, Corinna Gebauer, Peter Groneck, Friedhelm Heitmann, Thomas Hoehn, Mechthild Hubert, Angela Kribs, Helmut Küster, Reinhard Laux, Michael Mögel, Dirk Müller, Dirk Olbertz, Claudia Roll, Jens Siegel, Anja Stein, Matthias Vochem, Ursula Weller, Axel von der Wense, Christian Wieg, Jürgen Wintgens, Claudia Hemmelmann, Arne Simon, Egbert Herting, Wolfgang Göpel, for the German Neonatal Network (GNN)


We evaluated blood culture-proven sepsis episodes occurring in microclusters in very-low-birth-weight infants born in the German Neonatal Network (GNN) during 2009–2010.


Thirty-seven centers participated in GNN; 23 centers enrolled =50 VLBW infants in the study period. Data quality was approved by on-site monitoring. Microclusters of sepsis were defined as occurrence of at least two blood-culture proven sepsis events in different patients of one center within 3 months with the same bacterial species. For microcluster analysis, we selected sepsis episodes with typically cross-transmitted bacteria of high clinical significance including gram-negative rods and Enterococcus spp.


In our cohort, 12/2110 (0.6%) infants were documented with an early-onset sepsis and 235 late-onset sepsis episodes (=72 h of age) occurred in 203/2110 (9.6%) VLBW infants. In 182/235 (77.4%) late-onset sepsis episodes gram-positive bacteria were documented, while coagulase negative staphylococci were found to be the most predominant pathogens (48.5%, 95%CI: 42.01–55.01). Candida spp. and gram-negative bacilli caused 10/235 (4.3%, 95%CI: 1.68% –6.83%) and 43/235 (18.5%) late-onset sepsis episodes, respectively. Eleven microclusters of blood-culture proven sepsis were detected in 7 hospitals involving a total 26 infants. 16/26 cluster patients suffered from Klebsiella spp. sepsis. The median time interval between the first patient’s Klebsiella spp. sepsis and cluster cases was 14.1 days (interquartile range: 1–27 days). First patients in the cluster, their linked cases and sporadic sepsis events did not show significant differences in short term outcome parameters.


Microclusters of infection are an important phenomenon for late-onset sepsis. Most gram-negative cluster infections occur within 30 days after the first patient was diagnosed and Klebsiella spp. play a major role. It is essential to monitor epidemic microclusters of sepsis in surveillance networks to adapt clinical practice, inform policy and further improve quality of care.