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Matched Case-Control Analysis of Polymicrobial Bloodstream Infection In A Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Matthew J. Bizzarro ,
Louise-Marie Dembry ,
Robert S. Baltimore  and
Patrick G. Gallagher
Matthew J. Bizzarro
Affiliation:
Division of Perinatal Medicine, New Haven, Connecticut
Louise-Marie Dembry
Affiliation:
Department of Pediatrics, and the Department of Epidemiology and Public Health, New Haven, Connecticut Department of Internal Medicine, New Haven, Connecticut Yale University School of Medicine, and the Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Robert S. Baltimore
Affiliation:
Division of Infectious Diseases, New Haven, Connecticut Department of Pediatrics, and the Department of Epidemiology and Public Health, New Haven, Connecticut Yale University School of Medicine, and the Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Patrick G. Gallagher*
Affiliation:
Division of Perinatal Medicine, New Haven, Connecticut
*
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064 (patrick.gallagher@yale.edu)
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Abstract

Objective.

To compare and contrast the epidemiology of polymicrobial and monomicrobial bloodstream infections (BSIs) in newborn intensive care unit (NICU) patients.

Design.

Retrospective, matched case-control study.

Setting.

The Yale-New Haven Hospital NICU from 1989 through 2006.

Subjects.

NICU patients with BSIs.

Methods.

Each neonate with polymicrobial BSI (case patient) was matched to one neonate with monomicrobial BSI (control patient), by birth date, weight, and sex; and univariate and multivariate analyses were performed.

Results.

One hundred five cases of polymicrobial BSI were identified in 102 infants, representing 10% of all neonatal BSIs in our institution. Coagulase-negative staphylococci were the most common organisms recovered from culture. Infants with polymicrobial BSI had later onset of infection than infants with monomicrobial BSI (mean day of life, 37.5 vs 24.0; P< .001). Polymicrobial BSI occurred more frequently among infants with a severe underlying condition than in those without such a condition (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.2) and among infants requiring an indwelling central venous catheter for a prolonged duration (mean, 16.9 days, compared with 9.8 days for infants with monomicrobial BSI; P = .001). Multivariate analysis revealed that later onset of infection (adjusted OR [aOR], 1.02; 95% CI, 1.00-1.04) and presence of a severe underlying condition (aOR, 1.91; 95% CI, 1.12-3.38) were independent risk factors for polymicrobial BSI. No differences in outcome or mortality were observed.

Conclusions.

Changes in the microbiology and epidemiology of NICU-related polymicrobial BSI have occurred since the last North American review. In the present study, although differences were observed, most risk factors and outcomes were similar between monomicrobial BSI and polymicrobial BSI. Epidemiologic surveillance is critical to identify trends associated with neonatal polymicrobial BSI, particularly those that may impact preventative strategies, diagnostic measures, and therapeutic interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 10 , October 2008 , pp. 914 - 920
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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