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Multicenter Study
. 2014 Nov;35(11):1391-9.
doi: 10.1086/678410. Epub 2014 Oct 2.

Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections

Susan E Coffin  1 , Sarah B Klieger, Christopher Duggan, W Charles Huskins, Aaron M Milstone, Gail Potter-Bynoe, Bram Raphael, Thomas J Sandora, Xiaoyan Song, Danielle M Zerr, Grace M Lee; Pediatric Prevention EpiCenter Consortium
Affiliations
Multicenter Study

Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections

Susan E Coffin et al. Infect Control Hosp Epidemiol. 2014 Nov.

Abstract

Objective: To develop a candidate definition for central line-associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants.

Design: Multicenter retrospective cohort study.

Setting: Neonatal intensive care units from 14 US children's hospitals and pediatric facilities.

Methods: A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.

Results: During 2009-2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).

Conclusions: While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.

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Conflict of interest statement

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Microbiology of initial CLABSI reported from 376 NICU patients with (panel A) and without (panel B) an MBI-GI condition and recent PN exposure. *Poly Enteric = polymicrobial infection that included one or more MBI enteric organisms; *Poly Non-Enteric = polymicrobial infection that did not include any MBI enteric organisms.
Figure 2
Figure 2
Aggregate monthly CLABSI rate with all CLABSI (green) and non-MBI-GI CLABSI (red) included.
See this image and copyright information in PMC

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