Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-30T20:18:06.595Z Has data issue: false hasContentIssue false
  • English
  • Français

CLABSI Risk Factors in the NICU: Potential for Prevention: A PICNIC Study

Published online by Cambridge University Press:  09 September 2016

Maya Dahan ,
Shauna O’Donnell ,
Julie Hebert ,
Milagros Gonzales ,
Bonita Lee ,
A. Uma Chandran ,
Samantha Woolsey ,
Sandra Escoredo ,
Heather Chinnery  and
Caroline Quach
Maya Dahan
Affiliation:
Infection Control and Prevention, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
Shauna O’Donnell
Affiliation:
Infection Control and Prevention, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Julie Hebert
Affiliation:
Infection Control and Prevention, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada Departement of Pediatrics, University of Montreal, Montreal, Quebec, Canada
Milagros Gonzales
Affiliation:
Infection Control and Prevention, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
Bonita Lee
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
A. Uma Chandran
Affiliation:
Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
Samantha Woolsey
Affiliation:
Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
Sandra Escoredo
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
Heather Chinnery
Affiliation:
Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
Caroline Quach*
Affiliation:
Infection Control and Prevention, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
*
Address correspondence to Caroline Quach, MD, MSc, McGill University Health Center, E05-1954 – 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Central-line–associated bloodstream infections (CLABSI) are an important cause of morbidity and mortality in neonates. We aimed to determine whether intra-abdominal pathologies are an independent risk factor for CLABSI.

METHODS

We performed a retrospective matched case–control study of infants admitted to the neonatal intensive care units (NICUs) of the Montreal Children’s Hospital (Montreal) and the Royal Alexandra Hospital, Edmonton, Canada. CLABSI cases that occurred between April 2009 and March 2014 were identified through local infection control databases. For each case, up to 3 controls were matched (National Healthcare Safety Network [NHSN] birth weight category, chronological age, and central venous catheter (CVC) dwell time at the time of CLABSI onset). Data were analyzed using conditional logistic regression.

RESULTS

We identified 120 cases and 293 controls. According to a matched univariate analysis, the following variables were significant risk factors for CLABSI: active intra-abdominal pathology (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.8–6.4), abdominal surgery in the prior 7 days (OR, 3.5; 95% CI, 1.0–10.9); male sex (OR, 1.7; 95% CI, 1.1–2.6) and ≥3 heel punctures (OR, 4.0; 95% CI, 1.9–8.3). According to a multivariate matched analysis, intra-abdominal pathology (OR, 5.9; 95% CI, 2.5–14.1), and ≥3 heel punctures (OR, 5.4; 95% CI, 2.4–12.2) remained independent risk factors for CLABSI.

CONCLUSION

The presence of an active intra-abdominal pathology increased the risk of CLABSI by almost 6-fold. Similar to CLABSI in oncology patients, a subgroup of CLABSI with mucosal barrier injury should be considered for infants in the NICU with active intra-abdominal pathology.

Infect Control Hosp Epidemiol 2016;1446–1452

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1446 - 1452
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. Presented in part at IDWeek 2015, San Diego, California on October 9, 2015.

a

Primary coauthors with equal contribution.

References

REFERENCES

1. Hodge, D, Puntis, J. Diagnosis, prevention, and management of catheter related bloodstream infection during long term parenteral nutrition. Arch Dis Childhood Fetal Neonatal Edition 2002;87:F21–F24.Google Scholar
2. Timsit, JF. Diagnosis and prevention of catheter-related infections. Curr Opin Crit Care 2007;13:563–571.Google Scholar
3. Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (Epic) Study. Epic International Advisory Committee. JAMA 1995;274:639–644.Google Scholar
4. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR 2011;60:243–248.Google Scholar
5. Brodie, SB, Sands, KE, Gray, JE, et al. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J 2000;19:56–65.Google Scholar
6. Goldmann, DA, Freeman, J, Durbin, WA Jr. Nosocomial infection and death in a neonatal intensive care unit. J Infect Dis 1983;147:635–641.CrossRefGoogle Scholar
7. Goldmann, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449–459.Google Scholar
8. Geffers, C, Gastmeier, A, Schwab, F, Groneberg, K, Ruden, H, Gastmeier, P. Use of central venous catheter and peripheral venous catheter as risk factors for nosocomial bloodstream infection in very-low-birth-weight infants. Infect Control Hosp Epidemiol 2010;31:395–401.Google Scholar
9. Auriti, C, Maccallini, A, Di Liso, G, Di Ciommo, V, Ronchetti, MP, Orzalesi, M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003;53:25–30.Google Scholar
10. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.Google Scholar
11. de Brito, CS, de Brito, DV, Abdallah, VO, Gontijo Filho, PP. Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates. J Infect 2010;60:128–132.Google Scholar
12. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S22–S30.Google Scholar
13. Smith, MJ. Catheter-related bloodstream infections in children. Am J Infect Control 2008;36:S173.e171–e173.Google Scholar
14. Mahieu, LM, De Muynck, AO, Ieven, MM, De Dooy, JJ, Goossens, HJ, Van Reempts, PJ. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect 2001;48:108–116.Google Scholar
15. Advani, S, Reich, NG, Sengupta, A, Gosey, L, Milstone, AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 2011;52:1108–1115.Google Scholar
16. Adams-Chapman, I, Stoll, BJ. Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Curr Opin Infect Dis 2006;19:290–297.Google Scholar
17. Schlapbach, LJ, Aebischer, M, Adams, M, et al. Impact of sepsis on neurodevelopmental outcome in a swiss national cohort of extremely premature infants. Pediatrics 2011;128:e348–e357.Google Scholar
18. Shah, DK, Doyle, LW, Anderson, PJ, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008;153:170–175.Google Scholar
19. Bactériémies Sur Cathéters Centraux Aux Soins Intensifs: Résultats De Surveillance 2014–2015. SPIN - BACC-USI, 2015. Institut national de santé publique (INSPQ) website. https://www.inspq.qc.ca/printpdf/4224. Published 2015. Accessed January 31, 2016.Google Scholar
20. Public Health Agency of Canada. Central Venous Catheter-Associated Bloodstream Infections in Intensive Care Units in Canadian Acute-Care Hospitals: Surveillance Report January 1, 2006, to December 31, 2006, and January 1, 2009, to December 31, 2011. 2014.Google Scholar
21. Niedner, MF, Huskins, WC, Colantuoni, E, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2011;32:1200–1208.Google Scholar
22. Blanchard, AC, Fortin, E, Rocher, I, et al. Central line-associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol 2013;34:1167–1173.Google Scholar
23. Coffin, SE, Klieger, SB, Duggan, C, et al. central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections. Infect Control Hosp Epidemiol 2014;35:1391–1399.Google Scholar
24. Graham, PL 3rd, Begg, MD, Larson, E, Della-Latta, P, Allen, A, Saiman, L. Risk factors for late onset Gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J 2006;25:113–117.Google Scholar
25. Wiest, R, Rath, HC. Gastrointestinal disorders of the critically ill. bacterial translocation in the gut. Best Pract Res Clin Gastroenterol 2003;17:397–425.Google Scholar
26. Sherman, MP. New Concepts of microbial translocation in the neonatal intestine: mechanisms and prevention. Clin Perinatol 2010;37:565–579.Google Scholar
27. Gatt, M, Reddy, BS, MacFie, J. Review article: bacterial translocation in the critically ill—evidence and methods of prevention. Aliment Pharmacol Ther 2007;25:741–757.Google Scholar
28. MacFie, J, Reddy, BS, Gatt, M, Jain, PK, Sowdi, R, Mitchell, CJ. Bacterial translocation studied in 927 patients over 13 years. Br J Surg 2006;93:87–93.Google Scholar
29. Al-Rawajfah, OM, Stetzer, F, Hewitt, JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 2009;30:1036–1044.Google Scholar
30. Quach, C, Milstone, AM, Perpête, C, Bonenfant, M, Moore, DL, Perreault, T. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line–associated bloodstream infections. Infect Control Hosp Epidemiol 2014;35:158–163.Google Scholar
31. Bloodstream infection event (central-line-associated bloodstream infection and non-central line-associated bloodstream infection). Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Published 2013. Accessed January 31, 2016.Google Scholar
32. Wenzel, RP, Thompson, RL, Landry, SM, et al. Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 1983;4:371–375.Google Scholar
33. Taur, Y, Xavier, JB, Lipuma, L, et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012;55:905–914.Google Scholar
34. Feja, KN, Wu, F, Roberts, K, et al. Risk factors for candidemia in critically ill infants: a matched case–control study. J Pediatr 2005;147:156–161.Google Scholar
35. Saiman, L, Ludington, E, Pfaller, M, et al. Risk factors for candidemia in neonatal intensive care unit patients. The National Epidemiology of Mycosis Survey Study Group. Pediatr Infect Dis J 2000;19:319–324.Google Scholar
36. Squires, RH, Duggan, C, Teitelbaum, DH, et al. Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium. J Pediatr 2012;161:723–728.Google Scholar
37. Polin, RA, Denson, S, Brady, MT. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics 2012;129:e1104–e1109.Google Scholar
38. Waters, V, Larson, E, Wu, F, et al. Molecular epidemiology of Gram-negative bacilli from infected neonates and health care workers’hands in neonatal intensive care units. Clin Infect Dis 2004;38:1682–1687.Google Scholar
39. Aujoulat, F, Roudiere, L, Picaud, JC, et al. Temporal dynamics of the very premature infant gut dominant microbiota. BMC Microbiol 2014;14:325.Google Scholar
40. Healy, CM, Baker, CJ, Palazzi, DL, Campbell, JR, Edwards, MS. Distinguishing true coagulase-negative Staphylococcus infections from contaminants in the neonatal intensive care unit. J Perinatol 2013;33:52–58.Google Scholar
41. Onesimo, R, Fioretti, M, Pili, S, Monaco, S, Romagnoli, C, Fundaro, C. Is heel prick as safe as we think? BMJ Case Rep 2011. doi: 10.1136/bcr.08.2011.4677.Google Scholar