Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit

Mahieu, Ludo; Muynck, A.O. De; Ieven, M.; Dooy, Jozef J. De; Goossens, H.; Reempts, Patrick J Van

doi:10.1053/jhin.2001.0984

Cited by 121 publications

(84 citation statements)

References 24 publications

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“…In some countries, nasocomial bloodstream infections are observed in approximately half of the hospitalized patients and the mortality rate is increased up to 52% (11). The rate of nasocomial infection is reported to be 7% in Europe, 11.4% in USA and 16.7% in Spain (12)(13)(14). In the prospective 6-year study performed by Yap›c›o¤lu et al (15), the rate of infection was reported to range between 14% and 29% by years.…”

Section: Discussionmentioning

confidence: 98%

Yenidoğan yoğun bakım biriminde hastane kökenli kan akım enfeksiyonları

Bolat¹,

Uslu²,

Bülbül³

et al. 2011

tpa

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H Ho os sp pi it ta al l a ac cq qu ui ir re ed d b bl lo oo od ds st tr re ea am m i in nf fe ec ct ti io on ns s i in n n ne eo on na at ta al l i in nt te en ns si iv ve e c ca ar re e u un ni it t F Fa at ti ih h B Bo ol la at t, , S Si in na an n U Us sl lu u, , A Al li i B Bü ül lb bü ül l, , S Se er rd da ar r C Cö öm me er rt t, , E Em mr ra ah h C Ca an n, , E Ev vr ri im m K K› ›r ra ay y B Ba afl fl, , Ö Öm me er r G Gü ür ra an n, , A As si iy ye e N Nu uh ho o¤ ¤l lu u O Or ri ig gi in na al l A Ar rt ti ic cl le e S Su um mm ma ar ry yAim: The aim of this study was to evaluate the risk factors for term and preterm newborns, etiological agents, antibiotic susceptibility and rate of hospital acquired bloodstream infections among newborns hospitalized in our Neonatal Intensive Care Unit during the year of 2008. Material and Method:The medical records of patients were evaluated retrospectively. The risk factors for term and preterm babies were evaluated by multivariate logistic regression analysis. Results:During the one year period, 807 patients were hospitalized for longer than 72 hours. A total of 97 hemocultures were found to be positive. Among hemoculture positive newborns, 65.6% were found to be preterm and 34.4% term. The most common microorganisms identified were coagulase negative staphylococci and Klebsiella pneumonia. Blood stream infection rate, catheter related blood stream infection rate and ventilator associated pneumonia rate were found to be 5;9:1000 days, 9.6:1000 days and 13.8:1000 days, respectively. Glycopeptide resistance was not observed among gram positive microorganisms. Length of hospital stay, mechanical ventilation and presence of catheter were risk factors for hospital acquired infections. The mortality was found to be 12.5% among newborns with positive hemocultures. Conclusions:Hospital acquired infections are important causes of morbidity and mortality in neonatal intensive care units. The decrement of risk factors in term and preterm newborns would help to improve the outcome. (Turk Arch Ped 2011; 46: 130-6)

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Section: Discussionmentioning

confidence: 98%

Yenidoğan yoğun bakım biriminde hastane kökenli kan akım enfeksiyonları

Bolat¹,

Uslu²,

Bülbül³

et al. 2011

tpa

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“…6,7,12,[17][18][19][20] CRBSIs in hospitalized neonates are most frequently caused by coagulase-negative staphylococci. [2][3][4][5][6][7][8][9][10]17,18 Whereas the prophylactic use of systemic antibiotics at the time of catheter insertion has not been shown to reduce the incidence of catheter-related infection 21,22 by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from nal contaminants, has been shown to reduce the incidence of CRBSI in adults 24 and older children 25 with cuffed and tunneled central venous catheters. However, concerns have been raised that this novel form of local, extracorporeal, antimicrobial prophylaxis will promote resistance to vancomycin.…”

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confidence: 99%

“…Whereas most infections with short-term catheters derive from skin organisms that gain access extraluminally, [13][14][15][16] contamination of the catheter hub and lumen seems to be the predominant mechanism of CRBSI with long-term central venous catheters, including peripherally inserted central venous catheters. 6,7,12,[17][18][19][20] CRBSIs in hospitalized neonates are most frequently caused by coagulase-negative staphylococci. [2][3][4][5][6][7][8][9][10]17,18 Whereas the prophylactic use of systemic antibiotics at the time of catheter insertion has not been shown to reduce the incidence of catheter-related infection 21,22 and is strongly discouraged by the 2002 Guideline of the Hospital Infection Control Policy Advisory Committee of the Centers for Disease Control and Prevention (CDC), 23 the prophylactic use of a vancomycin-containing lock solution, instilled into the catheter lumen to eradicate intralumi-nal contaminants, has been shown to reduce the incidence of CRBSI in adults 24 and older children 25 with cuffed and tunneled central venous catheters.…”

mentioning

confidence: 99%

A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Venous Catheters: A Prospective, Randomized Trial

Garland¹,

Alex²,

Henrickson

et al. 2005

Pediatrics

156

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ABSTRACT. Objective. Critically ill neonates are at high risk for vascular catheter-related bloodstream infection (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices derive from intraluminal contaminants. The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI.Methods. A prospective, randomized double-blind trial was conducted during 2000 -2001 at a community hospital level III NICU. Very low birth weight and other critically ill neonates with a newly placed peripherally inserted central venous catheter were randomized to have the catheter locked 2 or 3 times daily for 20 or 60 minutes with heparinized normal saline (n ‫؍‬ 43) or heparinized saline that contained vancomycin 25 g/mL (n ‫؍‬ 42). The origin of each nosocomial bloodstream infection (BSI) was studied by culturing skin, catheter hubs, and implanted catheter segments and blood cultures, demonstrating concordance by restriction-fragment DNA subtyping. Surveillance axillary and rectal cultures were performed to detect colonization by vancomycin-resistant organisms. The main outcome measures were (1) CRBSIs and (2) colonization or infection by vancomycin-resistant Gram-positive bacteria.Results. Two (5%) of 42 infants in the vancomycinlock group developed a CRBSI as compared with 13 (30%) of 43 in the control group (2.3 vs 17.8 per 1000 catheter days; relative risk: 0.13; 95% confidence interval: 0.01-0.57). No vancomycin-resistant enterococci or staphylococci were recovered from any cultures. Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy. Twenty-six neonates (8 vancomycin-lock group, 18 control group) had at the end of a catheter-lock period asymptomatic hypoglycemia that resolved promptly when glucose-containing intravenous fluids were restarted.Conclusions. Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central catheters and did not promote vancomycin resistance but was associated with asymptomatic hypoglycemia. The use of an anti-infective lock solution for prevention of CRBSI with long-term intravascular devices has achieved proof of principle and warrants selective application in clinical practice. V ery low birth weight and other critically ill neonates require prolonged vascular access, which is now most widely achieved in current practice with peripherally inserted central venous catheters. 1 Prolonged vascular access in high-risk neonates is associated with a high risk for catheterrelated bloodstream infection (CRBSI), 2-6 which increases antibiotic exposure, length of stay, hospital costs, and mortality. 7-10 A bloodstream infection can occur during central venous therapy in as many as 20% to 30% of low birth weight neonates. 3,[5][6][7][8]10 For microorganisms to cause CRBSI, they first must gain access to the extraluminal or intraluminal surfaces of the implanted device, where ...

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“…Late-onset BSIs are more likely to be acquired from the hospital environment. Coagulase-negative staphylococci (CoNS), Candida species, and Gram-negative bacteria (e.g., E. coli, Klebsiella, Pseudomonas, Enterobacter, and Serratia species) are typical pathogens; prematurity, low birth weight, central venous catheters, mechanical ventilation, parenteral nutrition and a long hospital stay have been reported as risk factors for late-onset BSIs [10,11,[79][80][81].…”

Section: Bloodstream Infectionsmentioning

confidence: 99%

“…Without stratification, the heterogeneity of the study population could render comparisons between units, or over time in a single unit, invalid or misleading. For example, stratification by birth weight categories is recommended for NICU patients, because low birth weight has proved to be a significant risk factor for HAIs [10,11,64,74,76,79,80,194].…”

Section: Purpose and Objectives Of Surveillancementioning

confidence: 99%

314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit

Cited by 121 publications

References 24 publications

Yenidoğan yoğun bakım biriminde hastane kökenli kan akım enfeksiyonları

Yenidoğan yoğun bakım biriminde hastane kökenli kan akım enfeksiyonları

A Vancomycin-Heparin Lock Solution for Prevention of Nosocomial Bloodstream Infection in Critically Ill Neonates With Peripherally Inserted Central Venous Catheters: A Prospective, Randomized Trial

314 Healthcare-Associated Infections in Pediatrics

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