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. 2022 Nov;41(11):1327-1336.
doi: 10.1007/s10096-022-04502-8. Epub 2022 Sep 30.

A longitudinal analysis of nosocomial bloodstream infections among preterm neonates

Sophie J Jansen  1 , Alieke van der Hoeven  2 , Thomas van den Akker  3 , Marieke Veenhof  3 , Erik G J von Asmuth  4 , Karin Ellen Veldkamp  2 , Monique Rijken  5 , Martha van der Beek  2 , Vincent Bekker  5 , Enrico Lopriore  5
Affiliations

A longitudinal analysis of nosocomial bloodstream infections among preterm neonates

Sophie J Jansen et al. Eur J Clin Microbiol Infect Dis. 2022 Nov.

Abstract

Nosocomial bloodstream infections (NBSIs), commonly due to central-line associated bloodstream infections (CLABSI), contribute substantially to neonatal morbidity and mortality. We aimed to identify longitudinal changes in incidence of NBSI, microbiological-spectrum, and antibiotic exposure in a large cohort of preterm neonates admitted to the neonatal intensive care unit. We retrospectively assessed differences in annual rates of NBSI (per 1000 patient-days), CLABSI (per 1000 central-line days), and antibiotic consumption (per 1000 patient-days) among preterm neonates (< 32 weeks' gestation) hospitalized between January 2012 and December 2020. Multi-state Markov models were created to model states of progression of NBSI and infection risk given a central-line on days 0, 3, 7, and 10 of admission. Of 1547 preterm infants, 292 (19%) neonates acquired 310 NBSI episodes, 99 (32%) of which were attributed to a central-line. Over the years, a significant reduction in central-line use was observed (p < 0.001), although median dwell-time increased (p = 0.002). CLABSI incidence varied from 8.83 to 25.3 per 1000 central-line days, with no significant difference between years (p = 0.27). Coagulase-negative staphylococci accounted for 66% of infections. A significant decrease was found in antibiotic consumption (p < 0.001). Probability of NBSI decreased from 16% on day 3 to 6% on day 10. NBSI remains a common problem in preterm neonates. Overall antibiotic consumption decreased over time despite the absence of a significant reduction in infection rates. Further research aimed at reducing NBSI, in particular CLABSI, is warranted, particularly with regard to limiting central-line dwell-time and fine-tuning insertion and maintenance practices.

Keywords: Central-lines; Epidemiology; Hospital-acquired infections; Neonates.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Annual number of nosocomial bloodstream infection episodes per type
Fig. 2
Fig. 2
a and b U charts for overall central-line associated and nosocomial bloodstream infection rates per 6 months. Center line represents the central-limit (CL). Upper and lower lines represent the upper- and lower-control limits, respectively (UCL, LCL). LCL in Fig. 2b includes zero and is therefore not depicted
Fig. 3
Fig. 3
Annual number of central-lines per line type
Fig. 4
Fig. 4
Annual number of patient-days and antibiotic consumption rates. LOT, length of therapy; DOT, days of therapy. Plots display annual mean patient-days, LOT, and DOT rates with 95% confidence intervals. P values correspond to ANOVA test of the increase in model fit by adding year to Poisson regression
See this image and copyright information in PMC

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