Central Line-Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: developing a candidate definition for mucosal barrier injury bloodstream infections

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Coffin, Susan E. ; Klieger, Sarah B. ; Duggan, Christopher ; Huskins, W. Charles ; Milstone, Aaron M. ; Potter-Bynoe, Gail ; Raphael, Bram ; Sandora, Thomas J. ; Song, Xiaoyan ; Zerr, Danielle M. ; Lee, Grace M.
• Description:
  Objectives
  
  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.
  
  Design
  
  Multicenter retrospective cohort study
  
  Setting
  
  Neonatal intensive care units (NICU) from 14 U.S. children’s hospitals and pediatric facilities
  
  Methods
  
  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.
  
  Results
  
  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).
  
  Conclusions
  
  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.
  
  
• Subjects:
  Article Central Line Associated Bloodstream Infection Infant Neonate Surveillance
• Source:
  Infect Control Hosp Epidemiol. 35(11):1391-1399.
• Pubmed ID:
  25333434
• Pubmed Central ID:
  PMC4551075
• Document Type:
  Journal Article
• Funding:
  K24 HD058795/HD/NICHD NIH HHS/United States ; K24HD058795/HD/NICHD NIH HHS/United States ; U54-CK000163/CK/NCEZID CDC HHS/United States
• Volume:
  35
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:117de9572cf7acdd52717af6724951cedc86e47f952ad50d0767d1b44d4f17d4
• Download URL:
  https://stacks.cdc.gov/view/cdc/33115/cdc_33115_DS1.pdf
• File Type:
  [PDF - 413.81 KB ]