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

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Conference program

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