Shifting focus toward healthcare-associated bloodstream infections: The need for neonatal intensive care unit–specific NHSN definitions

Abstract

Objective: Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods: We performed a retrospective review of all neonates admitted to the 54-bed, level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013, and December 31, 2018. Clinical definitions per NICU team and NHSN site-specific definitions used for source identification were compared using the McNemar χ2 test. Results: We identified 86 HABSIs with an incidence rate of 0.80 per 1,000 patient days. Only 13% of these were CLABSIs. Both CLABSIs and non–catheter-related bloodstream infections occurred primarily in preterm neonates, but the latter were associated with a significantly higher incidence of comorbidities and the need for respiratory support. The NHSN definitions were less likely to identify a source compared to the clinical definitions agreed upon by our NICU treating team (P < .001). Furthermore, 50% of patients without an identified source of infection by NHSN definitions were bacteremic with a mucosal barrier injury organism, likely from gut translocation. Conclusions: HABSIs occur primarily in premature infants with comorbidities, and CLABSIs account for a small proportion of these infections. With the increasing focus on HABSI prevention, there is a need for better NHSN site-specific definitions for the NICU population to prevent misclassification and direct prevention efforts.

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

“…The risk of CLABSI is greater in preterm infants than in older infants, children, and adults due to the unique vulnerability of immature infants, their prolonged CVC dwell times, and their high-intensity critical care needs [17]. Major efforts have been made to control risk factors and reduce the CLABSI-associated burden [18][19][20]. One aspect that might influence the CLABSI rate is the type of CVC and the insertion technique [1,21].…”

CTX-M-15 Positive Escherichia coli and Klebsiella pneumoniae Outbreak in the Neonatal Intensive Care Unit of a Maternity Hospital in Ha’il, Saudi Arabia

“…1 The problem among these neonates in ICU settings is further complicated due to the use of broad-spectrum antibiotics, contact with healthcare workers (HCWs), and exposure to invasive and surgical procedures. 2 In outbreak settings, NICU patients are particularly vulnerable to colonization and infection with pathogens such as multidrug-resistant Gram-negative bacteria. 3 In the majority of cases, these healthcare-associated infections are caused by Escherichia coli and Klebsiella pneumoniae and require the administration of multiple antibiotics.…”

Nosocomial infections in neonatal care: a scoping review protocol of published surveillance case definitions

“…NI continue to be a serious public health issue worldwide even though it is estimated that approximately one third of these infections could be prevented by effective infection prevention programs (3) . Critically-ill infants admitted to the neonatal intensive care unit (NICU) in particular, are at an increased risk of neonatal nosocomial infections (NNI) due to impaired host-defense mechanisms, concomitant medical conditions, prolonged hospitalizations and frequent and long-lasting use of invasive medical devices (4) . NNI are associated with significant morbidity and mortality.…”