Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Verstraete, Evelien; Boelens, Jerina; Coen, Kris De; Claeys, Geert; Vogelaers, Dirk; Vanhaesebrouck, Piet; Blot, Stijn

doi:10.1086/675836

Cited by 52 publications

(40 citation statements)

References 31 publications

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“…ram-positive infections are an important cause of morbidity and mortality in neonatal and pediatric intensive care units (1,2). A significant rise in infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulasenegative staphylococci (CoNS) has led to increased use of glycopeptides in the last decade (3,4).…”

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confidence: 99%

Population Pharmacokinetics of Teicoplanin in Children

Ramos-Martín

Paulus

Siner

et al. 2014

Antimicrob Agents Chemother

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Teicoplanin is frequently administered to treat Gram-positive infections in pediatric patients. However, not enough is known about the pharmacokinetics (PK) of teicoplanin in children to justify the optimal dosing regimen. The aim of this study was to determine the population PK of teicoplanin in children and evaluate the current dosage regimens. A PK hospital-based study was conducted. Current dosage recommendations were used for children up to 16 years of age. Thirty-nine children were recruited. Serum samples were collected at the first dose interval (1, 3, 6, and 24 h) and at steady state. A standard 2-compartment PK model was developed, followed by structural models that incorporated weight. Weight was allowed to affect clearance (CL) using linear and allometric scaling terms. 2). A significant rise in infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulasenegative staphylococci (CoNS) has led to increased use of glycopeptides in the last decade (3, 4). Both vancomycin and teicoplanin are used for treatment of invasive infections caused by Gram-positive organisms, especially those that are resistant to ␤-lactam antibiotics (5, 6). The currently recommended regimen for teicoplanin in adults is 3 loading doses of 400 mg every 12 hours followed by a maintenance dose of 400 mg/day. In contrast, children receive 3 loading doses of 10 mg/kg of body weight every 12 hours followed by a maintenance dose of 10 mg/kg daily (7). However, there is a relative paucity of information to justify these regimens in children and even less information to identify optimal dosing strategies.Regulatory authorities such as the European Medicines Agency (EMA) have developed strategies to facilitate the safe and effective use of medicines in neonates and children (8). EMA supports the extrapolation of information from adults to children provided there are adequate safety data in the latter and the pharmacodynamics can reasonably assumed to be the same in both populations. This approach requires the development of robust population pharmacokinetic (PK) models in both adults and children, which facilitates the design of regimens that enable drug exposures in both populations to be matched (8).Teicoplanin is largely used without routinely measuring concentrations in the majority of pediatric patients. In our pediatric hospital setting, we have observed anecdotal cases of clinical failures with teicoplanin therapy and have observed "MIC creep" for CoNS with MICs at the breakpoint (4 mg/ liter) (unpublished data). To further investigate the clinical pharmacology of teicoplanin and to provide an insight into effective regimens for children, we performed a population PK study. The specific objectives of this study were to (i) describe the population PK of teicoplanin in children in a hospital setting, (ii) explore the percentage of patients attaining a predose minimum concentration (C min ) of Ͼ10 mg/liter, (iii) define the area under the concentration-time curve (AUC) distributions follo...

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confidence: 99%

Population Pharmacokinetics of Teicoplanin in Children

Ramos-Martín

Paulus

Siner

et al. 2014

Antimicrob Agents Chemother

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“…Previous studies document incidence rates ranging from 5% to 32%. [1][2][3][4] For neonates with very low birth weight (#1500 g), the National Institute for Child Health and Human Development reported an incidence of 21%. HABSIs result in longer hospitalization (on average, +23 days) and a rise in mortality rate up to 24% for very low birth weight neonates.…”

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confidence: 99%

Prediction Models for Neonatal Health Care–Associated Sepsis: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVES: Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. Data sources: LibHub, PubMed, and Web of Science. METHODS:The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for $48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters. RESULTS:The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity.CONCLUSIONS: Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.

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“…11 Late-onset neonatal sepsis is a significant risk factor for increased mortality and prolonged hospital stays, 12 although mortality is variable and related to the implicated pathogen. 13 In those who survive, there is poorer long-term growth and developmental outcomes, 14,15 with associated increased morbidity and increasing healthcare costs. 16 Prevention of CLABSI is a key objective for improvement of patient safety and reduction of mortality, hospital stay, and costs.…”

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Impact of a Central Line Infection Prevention Bundle in Newborn Infants

McMullan

Gordon

2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Cited by 52 publications

References 31 publications

Population Pharmacokinetics of Teicoplanin in Children

Population Pharmacokinetics of Teicoplanin in Children

Prediction Models for Neonatal Health Care–Associated Sepsis: A Meta-analysis

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

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