Incidence of Culture‐Proven Neonatal Sepsis and Its Correlation With Nurse Staffing in a Level IV Neonatal Intensive Care Unit: A Six‐Year Cohort Study

Abstract

ABSTRACT Aim To assess the incidence of culture‐proven sepsis and examine the correlation between positive blood cultures and nurse staffing in a Level IV neonatal intensive care unit (NICU). Methods This retrospective cohort study included neonates with ≥ 1 positive blood culture and signs of infection between 2018 and 2023. Infection episodes were defined as culture‐proven sepsis treated with antibiotics for ≥ 3 days and divided into early‐onset sepsis (EOS), ≤ 72 h after birth or late‐onset sepsis (LOS), > 72 h after birth. Nurse staffing was prospectively recorded and expressed as the ratio of actual to recommended attendance according to British Association of Perinatal Medicine standards. Results Among 6 856 admissions, 514 episodes of positive blood cultures were identified in 310 neonates; 421 (82%) were classified as infections. Coagulase‐negative staphylococci were the predominant pathogen. The incidence of positive blood cultures increased from 5.4% in 2018–2020 to 6.9% in 2021–2023. EOS increased (from 0.6% to 1.1%, p = 0.02). There was an inverse correlation between nurse staffing levels and number of LOS episodes ( p < 0.01). Conclusion Culture‐proven sepsis increased over time in this NICU, primarily driven by EOS. Higher numbers of LOS episodes correlated with lower nurse staffing levels, suggesting a potential role of adequate staffing in infection prevention.