To determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants.

Prospective observational study of very preterm infants born weighing 401 to 1500 g or at 22 to 29 weeks’ gestational age from January 2018 to December 2019 in 753 Vermont Oxford Network centers. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid in the 3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without EOS.

Of 84 333 included infants, 1139 had EOS for an incidence rate of 13.5 per 1000 very preterm births (99% confidence interval [CI] 12.5–14.6). Escherichia coli (538 of 1158; 46.5%) and group B Streptococcus (218 of 1158; 18.8%) were the most common pathogens. Infected infants had longer lengths of stay (median 92 vs 66 days) and lower rates of survival (67.5% vs 90.4%; adjusted risk ratio 0.82 [95% CI 0.79–0.85]) and of survival without morbidity (26.1% vs 59.4%; adjusted risk ratio 0.66 [95% CI 0.60–0.72]).

In a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Three-quarters of all infected infants either died or survived with a major medical morbidity. The profoundly negative impact of EOS on very preterm infants highlights the need for novel preventive strategies.

使用来自学术和社区医院的具有全国代表性的队列来确定极早产儿中早发性脓毒症 (EOS) 的流行病学和微生物学，以提供经验性抗生素指导，突出感染的危险因素，并帮助预测受感染的婴儿。

对 2018 年 1 月至 2019 年 12 月在 753 个佛蒙特州牛津网络中心出生体重 401 至 1500 克或胎龄 22 至 29 周的极早产儿进行的前瞻性观察研究。EOS定义为出生后3天内经培养证实的血液或脑脊液细菌感染。比较了有和没有 EOS 的婴儿的人口统计学、临床特征和结果。

在包括婴儿的 84 333 名婴儿中，1139 名患有 EOS，每 1000 名极早产的发病率为 13.5（99% 置信区间 [CI] 12.5-14.6）。大肠杆菌（1158 例中的 538 例；46.5%）和 B 组链球菌（1158 例中的 218 例；18.8%）是最常见的病原体。受感染婴儿的住院时间更长（中位数 92 天对 66 天），存活率更低（67.5% 对 90.4%；调整后的风险比 0.82 [95% CI 0.79–0.85]）和无病生存率（26.1% 对 59.4%） ; 调整后的风险比 0.66 [95% CI 0.60–0.72]）。

在 2018 年至 2019 年具有全国代表性的极早产儿 EOS 样本中，大约三分之一的分离株既不是 B 组链球菌也不是大肠杆菌。四分之三的受感染婴儿要么死于重大疾病，要么幸存下来。EOS 对早产儿的深刻负面影响凸显了对新型预防策略的需求。