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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

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

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.

Copyright

Corresponding author

Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium (evelienh.verstraete@ugent.be)

References

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