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the firm thank you to the organizing
committee for giving me the opportunity
to present these data i would like also
to acknowledge my collaborators on this
study this with spaghetti except see
study group led by a landslide back case
of bagger and krystal baby and also
Philip agreement and Matty stalker
actively participating in the annual
ongoing analyzes of the data and
presenting today so this prospective
observational study was launched in 10
pediatric clinics including five
university hospitals children less than
17 years of age with blood culture
proven sepsis where included between
September 2011 and december 2015 the
patients required a positive blood
culture and systemic inflammatory
response syndrome defined by at least
two signs including tachycardia
tachypnea increased up near frequency
temperature instability local Saito's is
leukopenia or left shift we excluded
positive cultures that we thought with
contaminants if we encountered pathogens
like bacterias like my microcode species
or offers contaminants for quality
negative staphylococci we are excluded
episodes where patients did not have a
central or peripheral teachers we also
excluded blood cultures growing a mix
flora of calculus negative staphylococci
or episodes where conditions decided to
stop treatment before five days overall
in the whole study we included 1300
children and among these children a
third where newborns so we have
444 episodes of blood culture proven
sepsis in 430 newborns 87 episodes were
considered to be early onset sepsis
defined as infection within the first
three days of life 357 episodes with
late-onset subsidies meaning infection
after three days of life among episodes
of late-onset sepsis we had 278 episodes
of hospital-acquired late-onset services
defined as infection presenting in a
patient in in the hospital for more than
two days and seventy nine episodes of
community-acquired late-onset sepsis
where infection was presenting before
admission to the hospital or within the
first two days of admission to
calculator to estimate the incidence of
community sepsis in Switzerland we
combine or data with data from the Swiss
Federal Office of statistics we assume
that we captured a hundred percent of
the sepsis episodes in infants born
before 42 weeks gestation ninety percent
of episodes for infants born between 32
and 36 weeks and eighty percent for
10-14 new walls so the incidence of
sepsis was 1.34 performs a nice berth
with point 274 audience etsy's point a
24 hospital-acquired late-onset
subsidies and point to 64
community-acquired late-onset ellipses
half of the patients in our court we're
protecting your bones as you can see in
this graph showing the incident
according to gestational age at verve
there is a peak in the extremely preterm
newborn which is mainly due to hospital
acquired late-onset sepsis and to a
minor proportion to already onset sepsis
the incidence of sepsis
in the very creature newborns with 7.2
person for early-onset sepsis it was one
person's hospital-acquired late-onset
his six percent and community-acquired
late-onset services point 1% we compared
our data with data from other countries
for early-onset sees the incidence is in
Switzerland was two to three-fold lower
compared to recently published studies
from the United States or from Europe
for late-onset Pepsi's we compare or
data in infants born before 32 weeks to
the the data from other countries and we
found that the incidence was also 2234
lower in Switzerland compared to studies
in North America Europe Australia and
New Zealand however we need to be a bit
cautious about comparing those data
because there is a clear gradient in in
time with the more recent studies
showing a lower incidence which reflects
our improvement in in unitl care then
this graph shows the the same numbers
that i showed you for the incidents
calculation but here we have the number
of episodes according to gestational age
again we find this peak in the extremely
preterm newborns but we now can see a
second peak interview born and this peak
in in blue is mainly due to
community-acquired late-onset sepsis
indeed we found that the median
gestational age at birth was very four
weeks for early-onset sexys 27 weeks for
hospital-acquired late-onset sepsis and
40 weeks for community-acquired
late-onset sees we found similar
differences of birth weight regarding
gender half of the patients with early
onset sepsis where means
fifty-nine percent of the patients with
hospital-acquired late-onset sepsis
where males and there was a strong
prevalence of means in that community
acquire late-onset cities with
75-percent of voice when do new bones
become septic the first day of life is
clearly a peak where 55 episodes were
diagnosed on the first day of life and
the second peak was between five and 15
next we looked at the focus of infection
first primary bloodstream infection
which means infection without focus was
diagnosed in seventy-eight percent of
cases of audience headset sees
twenty-three percent of
hospital-acquired late-onset services
and forty-six percent of
community-acquired late-onset gypsies as
expected central line-associated
subsidies was found almost exclusively
in the hospital acquired infections
accounting for forty-five percent of
cases meningitis was found in ten
percent of cases of early-onset
subsidies would three percent of
hospital-acquired late-onset services
and eleven percent of community-acquired
late-onset Pepsi's urinary tract
infection was found almost exclusively
in community-acquired late-onset senses
accounting for thirty-three percent of
episodes over clinical foci like
pneumonia abdominal soft tissue bone and
joint where less frequent and accounted
for less than ten percent of cases in
each subgroup severity of infection was
greater in early-onset sepsis and
hospital-acquired on types is compared
to community-acquired late-onset cities
as attested by a higher proportions of
patients with septic shock or requiring
non-invasive or invasive ventilation
mortality was eighteen percent in
early-onset sepsis twelve percent in
hospital acquired sepsis we found no
cases of death in community-acquired
late-onset tipsy's so when we analyze
those outcome we must keep in mind that
they also strongly related to
gestational age as you can see on this
graph where early onset is Gary the
mortality of fifty percent in extremely
preterm newborns while the mortalities
around ten percent in term ones then we
looked at pathogens in early-onset
Pepsi's group b streptococcus were the
number one pathogen followed by Sheree
coli in hospital acquired late-onset
Pepsi's there was a strong predominance
of Cuadrilla's negative staphylococci
followed by ecoli and staff stories in
community-acquired late-onset sees both
gps and e.coli accounted for more than
eighty percent of episodes we did some
subgroup analyzes in early-onset Xi's
equal i was the number-one pathogens for
preterm new bones and was less common in
german bonds for a GPS we found the
opposite number one pattern for a
newborn's less common in preterm your
bones this matches data from the richer
for hospital-acquired late-onset sepsis
we looked at pathogens associated with
high mortality and morbidity we found a
low rate of fungal infection as seven
cases and all of them were due to
candida albicans we found few cases of
pseudomonas originals are we also looked
at pathogens resistant to conventional
antibiotics we found a relatively low
number of mrs e five cases of
gram-negative bacteria expressing
extended-spectrum it'll act as
and only two cases a firm better Jen's
expressing job of animals for
community-acquired late-onset sepsis
most cases were due to ecoli and in
e.coli community-acquired on-site sepsis
cases were almost exclusively found in
males and there was a vast majority of
urosepsis in in those cases for GBS
community-acquired late-onset sepsis the
male predominance was less strong there
was no cases of urinary tract infection
and half of the patient presented his
primary bloodstream infection in
conclusion this study shows for the
first time a side-by-side comparison of
the three clinical and teaches of
neonatal sepsis early-onset
hospital-acquired late-onset and
community-acquired late-onset and shows
distinct demographics distinct clinical
presentation pathogens and outcomes we
have a relatively low incidence of
neonatal sepsis in Switzerland compared
to other industrialized countries for
early-onset ease its 2234 lower for
hospital-acquired lead entities it's
around 24 law however we must temper or
enthusiasm on these results because
mortality and short-term morbidity
remains significant in our study both
for audience sepsis and
hospital-acquired little incentive is
thanks for your attention

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Conference program

Welcome Words
M. Roth-Kleiner, R. Arlettaz Mieth
10 jan. 2017 · 9:33 matin
Short Reports Introduction
E. Giannoni, T. Karen, Resp. Lausanne, Zürich
10 jan. 2017 · 9:38 matin
Association of Axonal Injury and Preeclampsia
Katrina Evers, Neonatology UKBB
10 jan. 2017 · 9:39 matin
Q&A - Association of Axonal Injury and Preeclampsia
Katrina Evers, Neonatology UKBB
10 jan. 2017 · 9:44 matin
Retinopathy of Prematurity
Roland Gerull, Bern
10 jan. 2017 · 9:47 matin
Q&A - Retinopathy of Prematurity
Roland Gerull, Bern
10 jan. 2017 · 9:54 matin
Parechovirus Infection: A Rare Cause of Neonatal Encephalitis (in French)
Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne
10 jan. 2017 · 9:59 matin
Q&A - Parechovirus Infection: A Rare Cause of Neonatal Encephalitis
Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne
10 jan. 2017 · 10:04 matin
Genetic Susceptibility to Neonatal Group B Streptococcal Disease
Alessandro Borghesi, Fellay lab, EPFL
10 jan. 2017 · 10:17 matin
Q&A - Genetic Susceptibility to Neonatal Group B Streptococcal Disease
Alessandro Borghesi, Fellay lab, EPFL
10 jan. 2017 · 10:25 matin
Psychomotor Development in Children Prenatally Exposed to Methadone
G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva
10 jan. 2017 · 10:27 matin
Q&A - Psychomotor Development in Children Prenatally Exposed to Methadone
G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva
10 jan. 2017 · 10:34 matin
Introduction to Christoph Berger's Presentation
C. Kind, R. Gerull, Resp. St.Gallen, Bern
10 jan. 2017 · 10:37 matin
Vertical Infections: An Update
Christoph Berger, Zürich
10 jan. 2017 · 10:40 matin
Q&A - Vertical Infections: An Update
Christoph Berger, Zürich
10 jan. 2017 · 11:15 matin
Introduction to Eric Giannoni's Presentation
R. Pfister, S. Kämpfen, Resp. Geneva, Basel
10 jan. 2017 · 11:44 matin
Sepsis, Antibiotics and Resistances: Where Are We?
Christoph Bührer, Berlin
10 jan. 2017 · 2:21 après-midi
Use and Abuse of Antibiotics in Neonatology
Martin Stocker, Lucerne
10 jan. 2017 · 2:50 après-midi
Panel Discussion : Controversies on Use of Antibiotics in Neonatology
Martin Stocker, Christoph Berger, Eric Giannoni, Christoph Bührer
10 jan. 2017 · 3:10 après-midi
Introduction to Christoph Bührer's Presentation
Romaine Arlettaz Mieth , Neonatologist, Zürich, President of the Organizing Committee
10 jan. 2017 · 3:47 après-midi
Evidence-Based Haemodynamic Management in Neonatal Sepsis
Christoph Bührer, Berlin
10 jan. 2017 · 3:48 après-midi
Q&A - Evidence-Based Haemodynamic Management in Neonatal Sepsis
Christoph Bührer, Berlin
10 jan. 2017 · 4:16 après-midi
SwissNeoDose Project
Marc Pfister, Ped Pharmacology, UKBB
10 jan. 2017 · 4:20 après-midi
Awards (Case of the Year; Milupa; Best Poster Case Report; Best Oral Short Presentation) & Closing Comments
Matthias Roth-Kleiner, CHUV, President of the SSN
10 jan. 2017 · 4:30 après-midi