347 - Rise in early onset and Gram negative infections among very preterm infants in Canadian NICUs

Publication Number: 347.6529

Qi Zhou, Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Vann Chau, The Hospital for Sick Children, Toronto, ON, Canada; Eugene W. Yoon, Mount Sinai Hospital, Toronto, ON, Canada; Joseph Ting, University of Alberta, Edmonton, AB, Canada; Shoo K Lee, Mount Sinai Hospital, Toronto, ON, Canada

Background: We previously reported a decreasing trend of culture-positive infections among infants with GA < 33 weeks in Canadian NICUs from 2010-2018, with the decrease being mainly due to gram-positive bacteria, Coagulase-negative staphylococci (CoNS) and fungal infections, but not Gram-negative bacteria.

Objective: Our objective was to examine more recent data to determine continuing trends in infections rates among very preterm infants in Canadian NICUs, including early and late-onset infections and types of organisms.

Design/Methods: We conducted a retrospective cohort study of all very preterm infants < 33 weeks GA who were admitted to tertiary level NICUs participating in the Canadian Neonatal Network from January 1, 2010 to December 31, 2023. Infants who were moribund on admission, or with missing culture data were excluded. Culture positive infections (including blood and/or cerebrospinal fluid) and types of organisms were identified. Annual incidence of infections was estimated and trends examined using multivariable Poisson regression models, adjusting for gestational age, sex, Apgar score, small for gestational age status, mode of delivery and major congenital anomalies.

Results: The incidence of all infections was 4.49 cases/1000 patient days in 2010 and 3.53 cases/1000 patient days in 2023. There was a decreasing trend (per year) in overall infections (aOR 0.975, 95%CI 0.970-0.980) and late onset infections (aOR 0.967, 95%CI 0.981-0.972) from 2010 to 2023. There was an increasing trend of early onset infections (aOR 1.047, 95%CI 1.029-1.065), with the increase being mostly attributable to gram-negative bacteria (incidence 0.10 cases/1000 patient days in 2010; 0.29 cases/1000 patient days in 2023). There were no significant changes in the incidence of Gram-positive bacteria, CONS, fungi or viruses.

Conclusion(s): Overall, there was a decreasing trend in the incidence of all infections and late onset infections in Canadian NICUs from 2010 to 2023. However, there was an increasing trend of early onset infections, mainly attributable to gram negative bacteria.

Number of infection per 1000 patient days (Early onset sepsis + Late onset sepsis)


Number of infection per 1000 patient days (Early onset only)


Number of infections per 1000 patient days (late onset only)