Central Line-Associated Blood Stream Infections and Non–Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units

• Published in: The Journal of pediatrics Vol. 208; pp. 176 - 182.e6
• Main Authors: Zipursky, Amy R., Yoon, Eugene W., Emberley, Julie, Bertelle, Valerie, Kanungo, Jaideep, Lee, Shoo K., Shah, Prakesh S., Ting, Joseph, Cieslak, Zenon, Sherlock, Rebecca, Yee, Wendy, Toye, Jennifer, Fajardo, Carlos, Kalapesi, Zarin, Sankaran, Koravangattu, Daspal, Sibasis, Seshia, Mary, Alvaro, Ruben, Mukerji, Amit, Da Silva, Orlando, Nwaesei, Chuks, Lee, Kyong-Soon, Dunn, Michael, Lemyre, Brigitte, Dow, Kimberly, Pelausa, Ermelinda, Barrington, Keith, Lapoint, Anie, Drolet, Christine, Piedboeuf, Bruno, Claveau, Martine, Beltempo, Marc, Masse, Edith, Canning, Roderick, Makary, Hala, Ojah, Cecil, Monterrosa, Luis, Afifi, Jehier, Kajetanowicz, Andrzej
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2019
• Subjects: Bacteremia - epidemiology; Canada - epidemiology; Catheter-Related Infections - epidemiology; Catheterization, Central Venous - adverse effects; Central Venous Catheters - adverse effects; central-line associated blood stream infections; Cross Infection - epidemiology; Female; Gestational Age; gram negative; gram positive; Gram-Negative Bacteria - pathogenicity; Gram-Positive Bacteria - pathogenicity; hospital-acquired infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Meningitis - epidemiology; neonatal intensive care unit; preterm; Regression Analysis; Retrospective Studies; Sepsis - epidemiology; Tertiary Healthcare; Canada; gram positive; CLABSI; CNN; hospital-acquired infections; UVC; preterm; NICU; gram negative; central-line associated blood stream infections; CoNS; neonatal intensive care unit; CVL; SNAP-II
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2018.12.011

To determine if the reported reduction in hospital-acquired infections is due to reduced central line-associated blood stream infections (CLABSI) or non-CLABSIs.
A retrospective cohort study design was used to describe the change in organism pattern and incidence of hospital-acquired infections (CLABSIs and non-CLABSIs) in neonates <33 weeks of gestation admitted to tertiary neonatal intensive care units in the Canadian Neonatal Network between January 1, 2010, and December 31, 2016. Hospital-acquired infection was diagnosed when a pathogenic organism was isolated from blood or cerebrospinal fluid in a neonate with suspected sepsis. CLABSI was diagnosed when a central venous catheter was present at the time or removed in the 2 days before a hospital-acquired infection diagnosis. Cochran-Armitage and Mann-Kendall trend tests and linear regression models were used for statistical analyses.
Of 28 144 eligible neonates from 30 Canadian Neonatal Network neonatal intensive care units, 3306 (11.7%) developed hospital-acquired infections. There was a significant decrease in the rate of hospital-acquired infections (14.2% in 2010 and 9.2% in 2016; P < .01), and the rate of both CLABSIs and non-CLABSIs (P < .01) over the study period concomitant with a significant decrease in the duration of central line use (P = .01). The rates of meningitis also decreased during the study period (1.2% in 2010 and 0.9% in 2016; P < .01). Infections owing to gram-positive cocci significantly decreased, but infections owing to gram-negative organisms remained unchanged.
Although there was a significant decrease in CLABSIs and non-CLABSIs, hospital-acquired infections in preterm neonates remained high. Infections owing to gram-negative organisms remained unchanged and are a target for future preventative efforts.