Central Line-Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: developing a candidate definition for mucosal barrier injury bloodstream infections
Published Date:Oct 02 2014
Source:Infect Control Hosp Epidemiol. 35(11):1391-1399.
Pubmed Central ID:PMC4551075
Funding:K24 HD058795/HD/NICHD NIH HHS/United States
K24HD058795/HD/NICHD NIH HHS/United States
U54-CK000163/CK/NCEZID CDC HHS/United States
To develop a candidate definition for central line-associated blood stream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions; to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants.
Multicenter retrospective cohort study
Neonatal intensive care units (NICU) from 14 U.S. children’s hospitals and pediatric facilities
A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of a MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.
During 2009–12, 410 CLABSI occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSI were more likely to be caused by an enteric organism (22 of 34, 65% vs. 151 of 376, 40%; p = 0.009) and to meet the candidate MBI-GI CLABSI definition (19 of 34, 56% vs. 59 of 376, 16%; p < 0.01).
While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSI met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSI among subsequent infections suggests infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.
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