***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background : Sepsis is a leading cause of neonatal morbidity and mortality . Clinical suspicion may lead to overuse of antibiotics . The objective of this study was to assess the epidemiology of early-onset sepsis ( EOS ) and antibiotic exposure during the first week of life in Norwegian term infants . Methods : This is a nationwide population -based study from the Norwegian Neonatal Network . During the 3-year study period ( 2009–2011 ) , 20 of Norway ’s 21 neonatal units prospect ively collected data . Among 168,877 live-born ( LB ) term infants born during the study period , 10,175 ( 6.0 % ) infants were hospitalized in the first week of life and included in the study . Results : There were 91 cases of culture-confirmed EOS ( 0.54 per 1000 LB ) and 1447 cases classified as culture-negative EOS ( 8.57 per 1000 LB ) . The majority of culture-confirmed EOS cases were caused by Gram-positives ( 83/91 ; 91 % ) , most commonly group B streptococci ( 0.31 per 1000 LB ) . Intravenous antibiotics were administered to 3964 infants ; 39 % of all admissions and 2.3 % of all LB term infants . Empiric therapy consisted of an aminoglycoside and either benzylpenicillin or ampicillin in 95 % of the cases . The median ( interquartile range ) treatment duration was 8 ( 7–10 ) days for culture-confirmed EOS and 6 ( 5–7 ) days for culture-negative EOS . There was 1 EOS-attributable death ( group B streptococcal EOS ) during the study period . Conclusions : In this registry-based study , the incidence of culture-confirmed EOS was in line with previous international reports and the mortality was very low . A large proportion of infants without infection were treated with antibiotics . Measures should be taken to spare neonates unnecessary antibiotic treatment BACKGROUND OF THE STUDY Neonates at risk for early-onset sepsis are started on antibiotics empirically . Antibiotic resistance to conventionally used antibiotics is increasingly being reported . Antenatal maternal antibiotic exposure in this setting contributes to low yield on blood culture drawn at birth , limiting the planning of antibiotics based on culture reports . A head-to-head comparison for selecting the appropriate antibiotic is one strategy . OBJECTIVES To compare monotherapy with amikacin against piperacillin-tazobactum as an empirical therapy in neonates at risk for early-onset sepsis . DESIGN R and omized open-label controlled trial with stratification and block r and omization . SETTING S Tertiary care neonatal unit in India PARTICIPANTS All consecutive inborn neonates delivered between 01 May 2009 and 30 April 2011 who were ≥28 week gestation and /or ≥1000 g birth weight with risk factors for early-onset sepsis . INTERVENTION R and omized to receive either amikacin or piperacillin-tazobactum , after stratifying as asymptomatic or symptomatic within 1 h of birth . PRIMARY OUTCOME Incidence of treatment failure to the allocated antibiotic defined as blood culture isolate reported resistant to the allocated antibiotic or progression of the illness , necessitating a change of antibiotic . RESULTS Of 204 eligible cases , 187 were enrolled . Seventeen babies were excluded . A total of 128 neonates were stratified as asymptomatic and 59 as symptomatic . In all , 64 of the asymptomatic cases received amikacin and 64 received piperacillin-tazobactum , while 29 symptomatic babies received amikacin and 30 received piperacillin-tazobactum . Five babies had blood culture-positive sepsis , and 28 babies had strong suspicion of sepsis . There was no difference in the treatment failure in the amikacin group ( 3 of 93 ; 3.2 % ) compared with piperacillin-tazobactum group ( 2 of 94 ; 2.1 % ) ( p > 0.01 ) and no difference in the incidence of second infection , fungal sepsis and all-cause mortality at day 7 and 28 between the two study groups ( p > 0.01 ) . CONCLUSIONS Monotherapy with amikacin as an empirical antibiotic did not result in a higher incidence of treatment failure in neonates at risk for early-onset sepsis as compared with piperacillin-tazobactum . Both antibiotics were effective in management of babies with early-onset sepsis Yeasts may gain entry into the blood via routes such as intubation , intravenous catheterization or by direct persorption from the gut . The latter route becomes important when the numbers of commensal yeasts in the gut exceeds a threshold which may vary between animal species . In a prospect i ve study utilizing serial , twice weekly quantitative stool cultures during the first 6 weeks of life of 40 very low birth weight infants , we found a threshold of 8 x 10(6 ) C and ida colony-forming units/gram of stool . Beyond this threshold 50 % of the infants developed gastrointestinal symptoms and 28.5 % developed systemic sepsis within 1 to 3 weeks of heavy colonization . The gastrointestinal colonization rate was 62.5 % ( 25/40 ) with 66 % having C and ida colony-forming units greater than 8 x 10(6)/g stool A comparative study of bowel colonisation and incidence of necrotising enterocolitis in neonates admitted to an intensive care unit is reported . Neonates of less than 33 weeks gestational age requiring mechanical ventilation for respiratory distress syndrome were r and omised during the first week of life to receive either vancomycin and aztreonam or vancomycin and gentamicin for episodes of suspected sepsis after the first week of life . A higher proportion of neonates who received vancomycin and gentamicin had faecal colonisation with enterobacteriaceae at the end of the second , third , and fourth weeks of life . Treatment with vancomycin and aztreonam was associated with a rapid quantitative reduction in faecal colonisation with enterobacteriaceae , whereas there was no quantitative reduction in colonisation with enterobacteriaceae associated with treatment with vancomycin and gentamicin . There were no differences between the two groups in faecal colonisation with anaerobes , Enterococcus sp , Staphylococcus sp , or yeasts . Six ( 14.6 % ) of 41 who received vancomycin and gentamicin compared with 0 of 40 who received vancomycin and aztreonam subsequently developed necrotising enterocolitis Objectives . To investigate the incidence , causes , predictors , and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants . Methods . A prospect i ve study of survival of all infants with gestational age of < 28 weeks or birth weight of < 1000 g who were born in Norway in 1999–2000 was performed . Data on the maternal prenatal history , delivery , and neonatal course , including detailed information on episodes of microbiologically verified septicemia , were collected on predefined forms . Septicemia was reported in 2 groups , ie , episodes diagnosed on the day of delivery ( ie , very early-onset septicemia [ VEOS ] ) and episodes diagnosed from day 2 to day 7 of life ( ie , early-onset septicemia [ EOS ] ) . Logistic regression models were used for the selection of variables for predictor analysis in each group . Results . Of 462 included infants , VEOS occurred for 15 ( 32.5 per 1000 population ) and EOS for 15 ( 35.5 per 1000 population ) . The most prevalent bacteria were Escherichia coli in VEOS ( n = 9 ) and staphylococci ( coagulase-negative staphylococci and Staphylococcus aureus ) ( n = 15 ) in EOS . Case fatality rates were 40 % and 13 % , respectively . Independent predictive factors for VEOS were clinical chorioamnionitis ( odds ratio [ OR ] : 10.5 ; 95 % confidence interval [ CI ] : 3.3 - 33.4 ) and high maternal age ( OR : 1.2 ; 95 % CI : 1.0–1.3 ) , whereas not receiving systemic antibiotic therapy within 2 days of age ( OR : 13.6 ; 95 % CI : 3.7–50.2 ) and receiving nasal continuous positive airway pressure ( n-CPAP ) support at 24 hours of age ( OR : 9.8 ; 95 % CI : 2.5–38.4 ) independently predicted septicemia after the first day of life . Conclusions . Whereas vertically transmitted septicemia was dominated by Gram-negative bacteria , with predictors being exclusively of maternal origin , EOS was dominated by typically nosocomial flora , with n-CPAP treatment at 24 hours of age being a powerful predictor . Early n-CPAP treatment , as opposed to mechanical ventilation , as a powerful predictor of septicemia in the early neonatal period , even with adjustment for early systemic antibiotic treatment , is a new observation among extremely premature infants that warrants additional study Background . C and ida species are important nosocomial pathogens in neonatal intensive care unit ( NICU ) patients . Methods . A prospect i ve cohort study was performed in six geographically diverse NICUs from 1993 to 1995 to determine the incidence of and risk factors for c and idemia , including the role of gastrointestinal ( GI ) tract colonization . Study procedures included rectal swabs to detect fungal colonization and active surveillance to identify risk factors for c and idemia . C and ida strains obtained from the GI tract and blood were analyzed by pulsed field gel electrophoresis to determine whether colonizing strains caused c and idemia . Results . In all , 2847 infants were enrolled and 35 ( 1.2 % ) developed c and idemia ( 12.3 cases per 1000 patient discharges or 0.63 case per 1000 catheter days ) including 23 of 421 ( 5.5 % ) babies ≤1000 g. After adjusting for birth weight and abdominal surgery , forward multivariate logistic regression analysis demonstrated significant risk factors , including gestational age < 32 weeks , 5‐min Apgar < 5 ; shock , disseminated intravascular coagulopathy , prior use of intralipid , parenteral nutrition , central venous catheters , H2 blockers , intubation or length of stay > 7 days before c and idemia ( P < 0.05 ) . Catheters , steroids and GI tract colonization were not independent risk factors , but GI tract colonization preceded c and idemia in 15 of 35 ( 43 % ) case patients . Conclusions . C and ida spp . are an important cause of late onset sepsis in NICU patients . The incidence of c and idemia might be decreased by the judicious use of treatments identified as risk factors and avoiding H2 blockers OBJECTIVE Late-onset sepsis ( occurring after 3 days of age ) is an important problem in very low birth weight ( VLBW ) infants . To determine the current incidence of late-onset sepsis , risk factors for disease , and the impact of late-onset sepsis on subsequent hospital course , we evaluated a cohort of 7861 VLBW ( 401 to 1500 gm ) neonates admitted to the 12 National Institute of Child Health and Human Development ( NICHD ) Neonatal Research Network centers during a 32-month period ( 1991 to 1993 ) . METHODS The NICHD Neonatal Research Network maintains a prospect ively collected registry of all VLBW neonates cared for at participating centers . Data from this registry were analyzed retrospectively . RESULTS Of 6911 infants who survived beyond 3 days , 1696 ( 25 % ) had one or more episodes of blood culture-proven sepsis .  The vast majority of infection ( 73 % ) were caused by gram-positive organisms , with coagulase-negative staphylococci accounting for 55 % of all infections . Rate of infection was inversely related to birth weight and gestational age . Complications of prematurity associated with an increased rate of infection included intubation , respiratory distress syndrome , prolonged ventilation , bronchopulmonary dysplasia , patent ductus arteriosus , severe intraventricular hemorrhage , and necrotizing enterocolitis . Among infants with bronchopulmonary dysplasia , those with late-onset sepsis had a significantly longer duration of mechanical ventilation ( 45 vs 33 days ; p < 0.01 ) . Late-onset sepsis prolonged hospital stay : the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days , respectively ( p < 0.001 ) . Even after adjustment for other complications of prematurity , including intraventricular hemorrhage , necrotizing enterocolitis , and bronchopulmonary dysplasia , infants 
    Output:
    
Conclusions Prolonged antibiotic exposure in uninfected preterm infants is associated with an increased risk of NEC and /or death , and broad-spectrum antibiotic exposure is associated with an increased risk of IFI