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Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Published online by Cambridge University Press:  10 May 2016

Evelien Verstraete ,
Jerina Boelens ,
Kris De Coen ,
Geert Claeys ,
Dirk Vogelaers ,
Piet Vanhaesebrouck  and
Stijn Blot
Evelien Verstraete*
Affiliation:
Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
Jerina Boelens
Affiliation:
Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
Kris De Coen
Affiliation:
Department of Neonatal Medicine, Ghent University Hospital, Ghent, Belgium
Geert Claeys
Affiliation:
Laboratory of Clinical Biology, Ghent University Hospital, Ghent, Belgium
Dirk Vogelaers
Affiliation:
Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
Piet Vanhaesebrouck
Affiliation:
Department of Neonatal Medicine, Ghent University Hospital, Ghent, Belgium
Stijn Blot
Affiliation:
Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
*
Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium (evelienh.verstraete@ugent.be)
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Abstract

Objective.

To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992–2011).

Design.

Historical cohort study.

Setting.

Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital.

Patients.

Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD).

Methods.

A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition–days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis.

Results.

In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2–3.9). A significant increasing time trend in incidence density was observed for the period 1995–2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001).

Conclusions.

An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 5 , May 2014 , pp. 511 - 518
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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