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4 results

  • Central Line–Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: Developing a Candidate Definition for Mucosal Barrier Injury Bloodstream Infections

  • Susan E. Coffin, Sarah B. Klieger, Christopher Duggan, W. Charles Huskins, Aaron M. Milstone, Gail Potter-Bynoe, Bram Raphael, Thomas J. Sandora, Xiaoyan Song, Danielle M. Zerr, Grace M. Lee
  • Journal: Infection Control & Hospital Epidemiology / Volume 35 / Issue 11 / November 2014
  • Published online by Cambridge University Press: 10 May 2016, pp. 1391-1399
  • Print publication: November 2014
  • Objective.

    To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants

    Design.

    Multicenter retrospective cohort study.

    Setting.

    Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.

    Methods.

    A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.

    Results.

    During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).

    Conclusions.

    While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.

    Infect Control Hosp Epidemiol 2014;35(11):1391–1399