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Epidemiology of bacterial and fungal infections among level IV neonatal units in North America

Journal of Perinatology volume 45, pages 997–1004 (2025)Cite this article

Subjects

Abstract

Background

Neonatal infections cause significant morbidity and mortality. A comprehensive analysis of bloodstream infections (BSI), urinary tract infections (UTI) and meningitis across level IV neonatal intensive care units (NICUs) is lacking.

Methods

This retrospective cohort study utilized data from the Children’s Hospitals Neonatal Database (CHND) between January 2011 to December 2022. Patients with positive blood, urine, and cerebrospinal fluid (CSF) cultures were assessed. BSI trends across five geographic zones and a 10-year trend were studied.

Results

Of 172,921 patients, 15,541 (9.0%) had a culture-positive BSI, UTI, and/or meningitis. Within the 18,281 positive cultures (9794 BSI, 7097 UTI and 1390 CSF), 21,919 pathogens were identified. Infection rates were inversely related to gestational age. Pathogen distribution varied across regions, and over 10 years, Coagulase negative Staphylococcus declined, while E. coli and S. aureus proportions increased.

Conclusion

Understanding infection trends in level IV NICUs can inform targeted preventive strategies and quality improvement initiatives.

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Fig. 1: Flow diagram of patient numbers, positive cultures, and organisms identified.
Fig. 2: Venn Diagram of bloodstream infection (BSI), urinary tract infection (UTI) and meningitis.
Fig. 3: Proportion of bacterial and fungal organisms isolated from each infection category.
Fig. 4: 10-year trend of the most common bacterial organisms and Candida isolated from blood cultures.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber and Billie Short and ex-officio David Durand, Francine Dykes, Jeanette Asselin, are executive members of the Children’s Hospitals Neonatal Consortium, Inc., who developed and manage the CHND (thechnc.org). For more information, please contact: exec@thechnc.org. We appreciate Mr. John Mallett and Ms. Evelyn Werbaneth’s contribution to study design and data analysis. We are indebted to the above CHNC participating institutions that serve the infants and their families; these institutions have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND).

Funding

This study was supported by the Children’s Hospitals Neonatal Consortium, Mentored Fellow Research Award, and supported by NIH/NCATS Colorado CTSI Grant Number UL1 TR004399. NIH/NCATS Colorado CTSI Grant had no role in the design and conduct of this study; the contents are the authors’ sole responsibility and do not necessarily represent official NIH views.

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Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Yo Nishihara, Jeanne Zenge, Blair Weikel & Theresa Grover

  2. Children’s Hospitals Neonatal Consortium, Dover, DE, USA

    Isabella Zaniletti, Karna Murthy, Michael A. Padula & Theresa Grover

  3. Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Sarah Parker

  4. Ann & Robert H Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karna Murthy

  5. Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michael A. Padula

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  1. Yo Nishihara
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Contributions

YN and TG conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. JZ, SP, KM, MP critically reviewed and revised the manuscript. IZ designed the data collection instruments, collected data, carried out the initial analyses and critically reviewed and revised the manuscript. BW carried out the initial analysis and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yo Nishihara.

Ethics declarations

Competing interests

KM, MP, TG are Board members of the CHNC, a 501-c-3 Organization. The other authors do not have conflicts of interest to disclose.

Ethics approval

Research involving human subjects, human data is in accordance with the Declaration of Helsinki. The Stanley Manne Children’s Research Institute’s Institutional Review Board (Chicago, IL) provided oversight for this analysis (#2011-14673). Each participating site has IRB oversight to contribute to CHND.

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Nishihara, Y., Zaniletti, I., Zenge, J. et al. Epidemiology of bacterial and fungal infections among level IV neonatal units in North America. J Perinatol 45, 997–1004 (2025). https://doi.org/10.1038/s41372-025-02337-7

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