Epidemiology and Diagnosis of Health Care–Associated Infections in the NICU

Abstract

Health care−associated infections in the NICU are a major clinical problem resulting in increased morbidity and mortality, prolonged length of hospital stays, and increased medical costs. Neonates are at high risk for health care−associated infections because of impaired host defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of neonatal skin, the use of invasive procedures and devices, and frequent exposure to broad-spectrum antibiotics. This statement will review the epidemiology and diagnosis of health care−associated infections in newborn infants. Pediatrics 2012;129:e1104-e1109 INTRODUCTIONHealth care−associated infections are infections acquired in the hospital while receiving treatment of other conditions. They are common occurrences in patients of all ages and are estimated to result in 2 million infections, 90 000 deaths, and $28 to $45 billion in excess health care costs annually. 1,2 In the Pediatric Prevention Network national point prevalence survey, 11.2% of NICU patients had a health care−associated infection on the day of the survey. 3 Although there are no recent estimates of the cost of health care−associated infections in the NICU, Payne et al 4 estimated that health care-associated bloodstream infections added almost $100 million to the cost of treating infants with birth weights from 500 to 1499 g in 1999 dollars. Because this finding represented the excess costs associated with only one type of infection in one gestational age cohort, it provides just a glimpse of the financial impact of health care−associated infections in the NICU. This financial estimate does not include the potential morbidity and mortality concerns for the infant and the effect that the prolonged hospital stay has on the family and resource utilization within the hospital. Reducing health care−associated infections in the NICU would have benefits to infants, families, and the health care delivery system. The purpose of this technical report was to review the epidemiology and diagnosis of health care-associated infections in the NICU. A companion policy statement addresses strategies for the prevention of health care-associated infections. EPIDEMIOLOGYNewborn infants hospitalized in a NICU have host factors that not only make them more vulnerable to acquisition of health care-associated infections but also increase their risk of developing more serious illnesses. Whether an infant is born preterm or at term, many components of their innate and adaptive immune systems exhibit diminished function when compared with older children and adults. Infants with birth weights less than1500 g (very low birth weight) have rates of health care-associated infections 3 times higher than those who weigh greater than 1500 g at birth. However, the increased susceptibility to infection in infants of very low birth weight is multifactorial and related to both the developmental deficiencies in the innate and adaptive immune systems and a greate...

Increased frequency of peripheral venipunctures raises the risk of central-line associated bloodstream infection in neonates with peripherally inserted central venous catheters

“…This theory could be further supported by the observation that CoNS, as a member of commensal skin flora, was the most common pathogen isolated in PICC-associated CLA-BSI. 14,18,23 As a result, we designed this study, and our hypothesis was that the prolonged duration resulted in increased frequency of peripheral venipunctures. With the increased frequency of peripheral venipunctures, the possibility of transient bacteremia increased and it was more likely to cause bacteria colonization on PICC and subsequent CLA-BSI.…”

“…Gestational age was categorized as <32 weeks or !32 weeks. Birth weight was categorized as <1500 g or !1500 g. 1,23 Chronological age was grouped as 7 days or >7 days. The PICC duration was divided into three groups d 10 days, 11e20 days, and >20 days d in univariate analysis, and the frequency of peripheral venipunctures was grouped as <6 times and !6 times.…”

Intestinal carriage of methicillin-resistant Staphylococcus aureus in nasal MRSA carriers hospitalized in the neonatal intensive care unit

“…It has been reported that invasive nosocomial infections predominantly occur in children younger than 1 year of age, with an incidence of 14.7 per 100,000, versus 0.3-1.0 per 100,000 in older children [5] and the risk factors associated with an increased rate of infections in the neonatal intensive care unit (NICU) were suggested. These included the presence of invasive devices, exposure to broad-spectrum antibiotic agents, the use of parenteral nutrition, overcrowding and poor staffing ratios [12]. …”

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

“…[1][2][3][4][5][6][7] Pediatric hospital patients are especially vulnerable to adverse outcomes from AR infections due to factors such as immature immune systems, acquired or congenital immunodeficiencies, need for chronic parenteral nutrition, and congenital anomalies. 8 The unique impact HAIs have on pediatric patients is underscored by the fact that rates of device-associated infections are higher in some pediatric unit types than in corresponding adult units, despite a lower device utilization ratio.…”