Skip to main content Accessibility help

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

  • Evelien Verstraete (a1), Jerina Boelens (a2), Kris De Coen (a3), Geert Claeys (a4), Dirk Vogelaers (a1), Piet Vanhaesebrouck (a3) and Stijn Blot (a1)...



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


Historical cohort study.


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


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


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.


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).


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.


Corresponding author

Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium (


Hide All
1. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5)309332.
2. Gray, JW. A 7-year study of bloodstream infections in an English children's hospital. Eur J Pediatr 2004;163(9)530535.
3. Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110(2 pt 1)285291.
4. Perlman, SE, Saiman, L, Larson, EL. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007;35(3)177182.
5. Holmes, A, Dore, CJ, Saraswatula, A, et al. Risk factors and recommendations for rate stratification for surveillance of neonatal healthcare-associated bloodstream infection. J Hosp Infect 2008;68(1)6672.
6. Mahieu, LM, Buitenweg, N, Beutels, P, De Dooy, JT. Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit. J Hosp Infect 2001;47(3)223229.
7. Bizzarro, MJ, Raskind, C, Baltimore, RS, Gallagher, PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005; 116(3)595602.
8. Fanaroff, AA, Korones, SB, Wright, LL, et al; National Institute of Child Health and Human Development Neonatal Research Network. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. Pediatr Infect Dis J 1998;17(7)593598.
9. Stoll, BJ, Hansen, NI, Adams-Chapman, I, et al. Neurodevelop-mental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292(19): 2357-2365.
10. Pessoa-Silva, CL, Miyasaki, CH, de Almeida, MF, Kopelman, BI, Raggio, RL, Wey, SB. Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors. Eur J Epidemiol 2001;17(8)715720.
11. Stoll, BJ, Hansen, N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol 2003;27(4)293301.
12. Gladstone, IM, Ehrenkranz, RA, Edberg, SC, Baltimore, RS. A 10-year review of neonatal sepsis and comparison with the previous 50-year experience. Pediatr Infect Dis J 1990;9(11)819825.
13. Aly, H, Herson, V, Duncan, A, et al. Is bloodstream infection preventable among premature infants? a tale of two cities. Pediatrics 2005;115(6)15131518.
14. Bizzarro, MJ, Sabo, B, Noonan, M, et al. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010;31(3)241248.
15. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002;30(8)476489.
16. Modi, N, Dore, CJ, Saraswatula, A, et al. A case definition for national and international neonatal bloodstream infection surveillance. Arch Dis Child Fetal Neonatal Ed 2009;94(1):F8F12.
17. Schwab, F, Geffers, C, Barwolff, S, Ruden, H, Gastmeier, P. Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J Hosp Infect 2007;65(4)319325.
18. Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139(6)821827.
19. Zingg, W, Imhof, A, Maggiorini, M, Stocker, R, Keller, E, Ruef, C. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Crit Care Med 2009;37(7)21672173.
20. Lemaitre, D. Vergelijkend onderzoek naar het effect op het aantal cathetergerelateerde septicemieën bij kinderen met een zeer laag geboortegewicht door gebruik van transparante poly-uretha-neverbanden met verhoogde dampdoorlaatbaarheid [master's thesis]. Ghent University, 1995.
21. Zingg, W, Posfay-Barbe, KM, Pfister, RE, Touveneau, S, Pittet, D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011;32(l)4249.
22. Lessa, FC, Edwards, JR, Fridkin, SK, Tenover, FC, Horan, TC, Gorwitz, RJ. Trends in incidence of late-onset methicillin-resis-tant Staphylococcus aureus infection in neonatal intensive care units data from the National Nosocomial Infections Surveillance System, 1995-2004. Pediatr Infect Dis J 2009;28(7)577581.
23. Tiemersma, EW, Monnet, DL, Bruinsma, N, Skov, R, Monen, JC, Grundmann, H. Staphylococcus aureus bacteremia, Europe. Emerg Infect Dis 2005;11(11)17981799.
24. Bolat, F, Uslu, S, Bulbul, A, et al. Hospital acquired bloodstream infections in neonatal intensive care unit. Turk Arch Ped 2011;46(2)130136.
25. Brodie, SB, Sands, KE, Gray, JE, et al. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J 2000;19(1)5665.
26. Sarvikivi, E, Lyytikainen, O, Vaara, M, Saxen, H. Nosocomial bloodstream infections in children: an 8-year experience at a tertiary-care hospital in Finland. Clin Microbiol Infect 2008; 14(11)10721075.
27. Raymond, J, Aujard, Y; European Study Group. Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21(4)260263.
28. Tsai, MH, Hsu, JF, Chu, SM, et al. Incidence, clinical characteristics, and risk factors for adverse outcome in neonates with late onset sepsis. Pediatr Infect Dis J 2014;33(1):e7e13.
29. Freeman, JT, Chen, LF, Sexton, DJ, Anderson, DJ. Blood culture contamination with enterococci and skin organisms: implications for surveillance definitions of primary bloodstream infections. Am J Infect Control 2011;39(5)436438.
30. Sarkar, S, Bhagat, I, DeCristofaro, JD, Wiswell, TE, Spitzer, AR. A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. J Perinatol 2006;26(1):1822.
31. Goeschel, CA, Holzmueller, CG, Cosgrove, SE, Ristaino, P, Pronovost, PJ. Infection preventionist checklist to improve culture and reduce central line-associated bloodstream infections. Jt Comm J Qual Patient Saf 2010;36(12)571575.
32. Jean-Baptiste, N, Benjamin, DK, Cohen-Wolkowiez, M, et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2011;32(7)679686.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed