{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:46:21Z","timestamp":1761129981063,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002543","name":"Pusan National University","doi-asserted-by":"publisher","award":["2-year research grant"],"award-info":[{"award-number":["2-year research grant"]}],"id":[{"id":"10.13039\/501100002543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants. Methods: a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them. Results: a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group. Conclusions: in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.<\/jats:p>","DOI":"10.3390\/jcm11010260","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T01:14:02Z","timestamp":1641518042000},"page":"260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical and Laboratory Findings of Nosocomial Sepsis in Extremely Low Birth Weight Infants According to Causative Organisms"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1028-4225","authenticated-orcid":false,"given":"Kyung-Hee","family":"Park","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-Jung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mi-Hye","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong-Hee","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mun-Hui","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8281-6550","authenticated-orcid":false,"given":"Narae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6120-0490","authenticated-orcid":false,"given":"Young-Mi","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9034-5533","authenticated-orcid":false,"given":"Shin-Yun","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pusan National University Children\u2019s Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1056\/NEJMoa012657","article-title":"Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants","volume":"347","author":"Stoll","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F257","DOI":"10.1136\/archdischild-2014-306213","article-title":"Late-onset neonatal sepsis: Recent developments","volume":"100","author":"Dong","year":"2015","journal-title":"Arch. Dis. Child.-Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1097\/INF.0000000000002408","article-title":"Gram-negative Late-onset Sepsis in Extremely Low Birth Weight Infants Is Emerging in The Netherlands Despite Quality Improvement Programs and Antibiotic Stewardship!","volume":"38","author":"Ran","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_4","first-page":"28","article-title":"Choice of antibiotics in late neonatal sepsis in the extremely low birth weight infant","volume":"14","author":"Allen","year":"2003","journal-title":"Can. J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bekhof, J., Kollen, B.J., Kok, J.H., and Van Straaten, H.L. (2015). Glucosuria as an early marker of late-onset sepsis in preterms: A prospective cohort study. BMC Pediatr., 15.","DOI":"10.1186\/s12887-015-0425-5"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1542\/peds.106.4.712","article-title":"When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia","volume":"106","author":"Benjamin","year":"2000","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa010494","article-title":"Fluconazole prophylaxis against fungal colonization and infection in preterm infants","volume":"345","author":"Kaufman","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"F188","DOI":"10.1136\/adc.2005.082024","article-title":"Invasive fungal infection in very low birthweight infants: National prospective surveillance study","volume":"91","author":"Clerihew","year":"2006","journal-title":"Arch. Dis. Child.-Fetal. Neonatal Ed."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Guida, J.D., Kunig, A.M., Leef, K.H., McKenzie, S.E., and Paul, D.A. (2003). Platelet count and sepsis in very low birth weight neonates: Is there an organism-specific response?. Pediatrics, 1411\u20131415.","DOI":"10.1542\/peds.111.6.1411"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/INF.0000000000001570","article-title":"Late-onset Sepsis in Extremely Premature Infants: 2000\u20132011","volume":"36","author":"Greenberg","year":"2017","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.clp.2009.12.001","article-title":"Adjunct laboratory tests in the diagnosis of early-onset neonatal sepsis","volume":"37","author":"Benitz","year":"2010","journal-title":"Clin. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.pcl.2004.03.009","article-title":"Diagnosis and management of bacterial infections in the neonate","volume":"51","author":"Gerdes","year":"2004","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1542\/peds.110.4.e42","article-title":"Pediatric Prevention Network: Evaluation and treatment of neonates with suspected late-onset sepsis: A survey of neonatologists\u2019 practices","volume":"110","author":"Rubin","year":"2002","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/INF.0b013e31822ffc17","article-title":"Use of leukocyte counts in evaluation of early-onset neonatal sepsis","volume":"31","author":"Murphy","year":"2012","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/j.1651-2227.2002.tb02913.x","article-title":"Late-onset neutropenia in very low birthweight infants","volume":"91","author":"Chirico","year":"2002","journal-title":"Acta Paediatr. Suppl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E55","DOI":"10.1542\/peds.106.4.e55","article-title":"Late-onset neutropenia in very low birth weight infants","volume":"106","author":"Omar","year":"2000","journal-title":"Pediatrics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1097\/INF.0b013e318256905c","article-title":"Use of the complete blood cell count in early-onset neonatal sepsis","volume":"31","author":"Hornik","year":"2012","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1038\/sj.jp.7211554","article-title":"Can neutrophil responses in very low birth weight infants predict the organisms responsible for late-onset bacterial or fungal sepsis?","volume":"26","author":"Sarkar","year":"2006","journal-title":"J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/ped.14123","article-title":"Red cell distribution width as a predictor of late-onset Gram-negative sepsis","volume":"62","author":"Dogan","year":"2020","journal-title":"Pediatr. Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Benjamin, D.K., DeLong, E.R., Steinbach, W.J., Cotton, C.M., Walsh, T.J., and Clark, R.H. (2003). Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics, 543\u2013547.","DOI":"10.1542\/peds.112.3.543"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5139","DOI":"10.4049\/jimmunol.166.8.5139","article-title":"Platelet-activating factor-induced early activation of NF-kappa B plays a crucial role for organ clearance of Candida albicans","volume":"166","author":"Choi","year":"2001","journal-title":"J. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ree, I.M.C., Fustolo-Gunnink, S.F., Bekker, V., Fijnvandraat, K.J., Steggerda, S.J., and Lopriore, E. (2017). Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185581"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Beltempo, M., Viel-Th\u00e9riault, I., Thibeault, R., Julien, A.S., and Piedboeuf, B. (2018). C-reactive protein for late-onset sepsis diagnosis in very low birth weight infants. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1002-5"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3109\/07853890009011772","article-title":"Function of C-reactive protein","volume":"32","year":"2000","journal-title":"Ann. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"237","DOI":"10.3109\/14767058.2014.908842","article-title":"CRP levels in extremely low birth weight (ELBW) septic infants","volume":"28","author":"Dritsakou","year":"2015","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1093\/clinchem\/48.7.1103","article-title":"C-reactive protein kinetics in newborns: Application of a high-sensitivity analytic method in its determination","volume":"48","author":"Ishibashi","year":"2002","journal-title":"Clin. Chem."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.cca.2011.02.020","article-title":"C reactive protein and procalcitonin: Reference intervals for preterm and term newborns during the early neonatal period","volume":"412","author":"Chiesa","year":"2011","journal-title":"Clin. Chim. Acta"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1155\/2012\/198383","article-title":"Coagulase-negative Staphylococcus, catheter-related, bloodstream infections and their association with acute phase markers of inflammation in the intensive care unit: An observational study","volume":"23","author":"Rewa","year":"2012","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_29","first-page":"79","article-title":"Different pro-inflammatory and immunogenic potentials of Propionibacterium acnes and Staphylococcus epidermidis: Implications for chronic inflammatory acne","volume":"53","author":"Mak","year":"2005","journal-title":"Arch. Immunol. Ther. Exp."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kilbride, H.W., Wirtschafter, D.D., Powers, R.J., and Sheehan, M.B. (2003). Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics, e519\u2013e533.","DOI":"10.1542\/peds.111.SE1.e519"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kilbride, H.W., Powers, R., Wirtschafter, D.D., Sheehan, M.B., Charsha, D.S., LaCorte, M., Finer, N., and Goldmann, D.A. (2003). Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia. Pediatrics, e504\u2013e518.","DOI":"10.1542\/peds.111.SE1.e504"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1038\/sj.jp.7211593","article-title":"Hyperglycemia and morbidity and mortality in extremely low birth weight infants","volume":"26","author":"Kao","year":"2006","journal-title":"J. Perinatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1111\/j.1651-2227.2006.tb02266.x","article-title":"Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates","volume":"95","author":"Manzoni","year":"2006","journal-title":"Acta Paediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0095-5108(05)70004-X","article-title":"Glucose homeostasis in the micropremie","volume":"27","author":"Farrag","year":"2000","journal-title":"Clin. Perinatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1542\/peds.2006-1311","article-title":"Risk factors for progression to invasive fungal infection in preterm neonates with fungal colonization","volume":"118","author":"Manzoni","year":"2006","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/INF.0000000000000024","article-title":"Clinical and laboratory factors that predict death in very low birth weight infants presenting with late-onset sepsis","volume":"33","author":"Levit","year":"2014","journal-title":"Pediatric Infect. Dis. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/260\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:36:20Z","timestamp":1760362580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,4]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["jcm11010260"],"URL":"https:\/\/doi.org\/10.3390\/jcm11010260","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,1,4]]}}}