Central Line–Associated Bloodstream Infection in neonatal intensive care units

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#IVTEAM #Intravenous literature: Blanchard, A.C., Fortin, E., Rocher, I., Moore, D.L., Frenette, C., Tremblay, C. and Quach, C. (2013) Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units. Infection Control and Hospital Epidemiology. 34(11), p.1167-1173

Abstract:

Objective: Describe the epidemiology of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.

Design: Retrospective cohort. Setting. We included patients admitted (April 2007–March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).

Methods: CLABSIs/1,000 central line–days and device utilization ratio were calculated; χ2 test, Student t test, Kruskal-Wallis, and Poisson regression were used.

Results: Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line–days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007–2008 to 5.1 CLABSIs/1,000 central line–days in 2010–2011 ( ). The all-cause 30-day case fatality proportion was 8.9% ( ) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology ( ) and the proportion of pulmonary pathology ( ) reported.

Conclusion: The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.

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