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Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Ana C. Blanchard ,
Elise Fortin ,
Isabelle Rocher ,
Dorothy L. Moore ,
Charles Frenette ,
Claude Tremblay  and
Caroline Quach
Ana C. Blanchard
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Elise Fortin
Affiliation:
Direction des Risques Biologiques et de la Santé au Travail, Quebec Institute of Public Health, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
Isabelle Rocher
Affiliation:
Direction des Risques Biologiques et de la Santé au Travail, Quebec Institute of Public Health, Montreal, Quebec, Canada
Dorothy L. Moore
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Charles Frenette
Affiliation:
Department of Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
Claude Tremblay
Affiliation:
Department of Microbiology, Centre Hospitalier Universitaire de Québec, Pavillon Hôtel-Dieu de Québec, Quebec City, Quebec, Canada
Caroline Quach*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada Direction des Risques Biologiques et de la Santé au Travail, Quebec Institute of Public Health, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Department of Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
*
Montreal Children's Hospital, 2300 Tupper Street, Room C1242, Montreal, Quebec H3H 1P3, Canada (caroline.quach@mcgill.ca)
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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; x2 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 (P = .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) 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 (P = .007) and the proportion of pulmonary pathology (P = .016) 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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 11 , November 2013 , pp. 1167 - 1173
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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