Central Line-Associated Blood Stream Infections and Non–Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units - 24/04/19

Doi : 10.1016/j.jpeds.2018.12.011

Amy R. Zipursky, MD ¹, Eugene W. Yoon, MSc ², Julie Emberley, MD ³, Valerie Bertelle, MD ⁴, Jaideep Kanungo, MD ^5,⁶, Shoo K. Lee, FRCPC ^1,^2,^7,⁸, Prakesh S. Shah, MD ^1,^2,⁷
on behalf of the
Canadian Neonatal Network Investigators^{^∗}
List of the Canadian Neonatal Network Investigators is available at www.jpeds.com (Appendix).
Joseph Ting, MD, Zenon Cieslak, MD, Rebecca Sherlock, MD, Wendy Yee, MD, Jennifer Toye, MD, Carlos Fajardo, MD, Zarin Kalapesi, MD, Koravangattu Sankaran, MD, MBBS, Sibasis Daspal, MD, Mary Seshia, MBChB, Ruben Alvaro, MD, Amit Mukerji, MD, Orlando Da Silva, MD, MSc, Chuks Nwaesei, MD, Kyong-Soon Lee, MD, MSc, Michael Dunn, MD, Brigitte Lemyre, MD, Kimberly Dow, MD, Ermelinda Pelausa, MD, Keith Barrington, MBChB, Anie Lapoint, MD, Christine Drolet, MD, Bruno Piedboeuf, MD, Martine Claveau, MSc, LLM, NNP, Marc Beltempo, MD, Edith Masse, MD, Roderick Canning, MD, Hala Makary, MD, Cecil Ojah, MBBS, Luis Monterrosa, MD, Jehier Afifi, MB BCh, MSc, Andrzej Kajetanowicz, MD

¹ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
² Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
³ Department of Pediatrics, Janeway Children's Health & Rehabilitation Center and Memorial University of Newfoundland, St. John's, Newfoundland, Canada
⁴ Department of Pediatrics, University of Sherbrooke, Sherbrooke, Quebec, Canada
⁵ Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
⁶ Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
⁷ Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
⁸ Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Abstract

Objective

To determine if the reported reduction in hospital-acquired infections is due to reduced central line-associated blood stream infections (CLABSI) or non-CLABSIs.

Study design

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.

Results

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.

Conclusion

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.

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Keywords : hospital-acquired infections, preterm, gram negative, gram positive, central-line associated blood stream infections, neonatal intensive care unit

Abbreviations : CLABSI, CNN, CoNS, CVL, NICU, SNAP-II, UVC

Plan

Although no specific funding was received for this study, organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team grant (CTP 87518), the Ontario Ministry of Health, and in-kind support from Mount Sinai Hospital. P.S. holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR126340). The authors declare no conflicts of interest.

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P. 176 - mai 2019 Retour au numéro

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Central Line-Associated Blood Stream Infections and Non–Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units - 24/04/19

Abstract

Objective

Study design

Results

Conclusion

Plan

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