Intravenous literature: Hocevar, S.N., Edwards, J.R., Horan, T.C., Morrell, G.C., Iwamoto, M. and Lessa, F.C. (2012) Device-Associated Infections among Neonatal Intensive Care Unit Patients: Incidence and Associated Pathogens Reported to the National Healthcare Safety Network, 2006â€“2008. Infection Control and Hospital Epidemiology.Â 33(12), p.1200-1206.
Objective: To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (childrenâ€™s vs general hospitals).
Patients and setting: Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008.
Methods: We analyzed central lineâ€“associated bloodstream infections (CLABSIs), umbilical catheterâ€“associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used.
Results: Pooled mean incidence rates by birth weight category (750 g or less, 751â€“1,000 g, 1,001â€“1,500 g, 1,501â€“2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in childrenâ€™s hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant.
Conclusions: Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between childrenâ€™s and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings.