Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T00:46:51.492Z Has data issue: false hasContentIssue false
  • English
  • Français

Matched Case-Control Analysis of Polymicrobial Bloodstream Infection In A Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Matthew J. Bizzarro ,
Louise-Marie Dembry ,
Robert S. Baltimore  and
Patrick G. Gallagher
Matthew J. Bizzarro
Affiliation:
Division of Perinatal Medicine, New Haven, Connecticut
Louise-Marie Dembry
Affiliation:
Department of Pediatrics, and the Department of Epidemiology and Public Health, New Haven, Connecticut Department of Internal Medicine, New Haven, Connecticut Yale University School of Medicine, and the Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Robert S. Baltimore
Affiliation:
Division of Infectious Diseases, New Haven, Connecticut Department of Pediatrics, and the Department of Epidemiology and Public Health, New Haven, Connecticut Yale University School of Medicine, and the Department of Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Patrick G. Gallagher*
Affiliation:
Division of Perinatal Medicine, New Haven, Connecticut
*
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To compare and contrast the epidemiology of polymicrobial and monomicrobial bloodstream infections (BSIs) in newborn intensive care unit (NICU) patients.

Design.

Retrospective, matched case-control study.

Setting.

The Yale-New Haven Hospital NICU from 1989 through 2006.

Subjects.

NICU patients with BSIs.

Methods.

Each neonate with polymicrobial BSI (case patient) was matched to one neonate with monomicrobial BSI (control patient), by birth date, weight, and sex; and univariate and multivariate analyses were performed.

Results.

One hundred five cases of polymicrobial BSI were identified in 102 infants, representing 10% of all neonatal BSIs in our institution. Coagulase-negative staphylococci were the most common organisms recovered from culture. Infants with polymicrobial BSI had later onset of infection than infants with monomicrobial BSI (mean day of life, 37.5 vs 24.0; P< .001). Polymicrobial BSI occurred more frequently among infants with a severe underlying condition than in those without such a condition (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.2) and among infants requiring an indwelling central venous catheter for a prolonged duration (mean, 16.9 days, compared with 9.8 days for infants with monomicrobial BSI; P = .001). Multivariate analysis revealed that later onset of infection (adjusted OR [aOR], 1.02; 95% CI, 1.00-1.04) and presence of a severe underlying condition (aOR, 1.91; 95% CI, 1.12-3.38) were independent risk factors for polymicrobial BSI. No differences in outcome or mortality were observed.

Conclusions.

Changes in the microbiology and epidemiology of NICU-related polymicrobial BSI have occurred since the last North American review. In the present study, although differences were observed, most risk factors and outcomes were similar between monomicrobial BSI and polymicrobial BSI. Epidemiologic surveillance is critical to identify trends associated with neonatal polymicrobial BSI, particularly those that may impact preventative strategies, diagnostic measures, and therapeutic interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 10 , October 2008 , pp. 914 - 920
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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.)

References

1.Rolston, K VI, Bodey, GP, Safdar, A. Polymicrobial infection in patients with cancer: an underappreciated and underreported entity. Clin Infect Dis 2007;45:228–233.CrossRefGoogle ScholarPubMed
2.Jarvis, WR, Highsmith, AK, Allen, JR, Haley, RW. Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit. Pediatr Infect Dis 1983;2:203–208.CrossRefGoogle Scholar
3.Faix, RG, Kovarik, SM. Polymicrobial sepsis among intensive care nursery infants. J Perinatol 1989;9:131–136.Google ScholarPubMed
4.Gupta, P, Kumhar, GD, Kaur, G, Ramachandran, VG. Clinical significance of polymicrobial bacteremia in newborns. J Paediatr Child Health 2005;41:365–368.CrossRefGoogle ScholarPubMed
5.Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.CrossRefGoogle ScholarPubMed
6.Christie, C, Hammond, J, Reising, S, Evans-Patterson, J. Clinical and molecular epidemiology of enterococcal bacteremia in a pediatric teaching hospital. J Pediatr 1994;125:392–399.CrossRefGoogle Scholar
7.Fairchild, KD, Tomkoria, S, Sharp, EC, Mena, FV. Neonatal Candida glabrata sepsis: clinical and laboratory features compared with other Candida species. Pediatr Infect Dis J 2002;21:39–43.CrossRefGoogle ScholarPubMed
8.Kiani, D, Quinn, EL, Burch, KH, Madhavan, T, Saravolatz, LD, Neblett, TR. The increasing importance of polymicrobial sepsis. JAMA 1979;242:1044–1047.CrossRefGoogle Scholar
9.Weinstein, MP, Reller, LB, Murphy, JR. Clinical importance of polymicrobial bacteremia. Diagn Microbiol Infect Dis 1986;5:185–196.CrossRefGoogle ScholarPubMed
10.Reuben, AG, Musher, DM, Hamill, RJ, Broucke, I. Polymicrobial bacteremia: clinical and microbiologic patterns. Rev Infect Dis 1989;11:161–183.CrossRefGoogle ScholarPubMed
11.Pittet, D, Li, N, Wenzel, RP. Association of secondary and polymicrobial nosocomial bloodstream infections with higher mortality. Eur J Clin Microbiol Infect Dis 1993;12:813–819.CrossRefGoogle ScholarPubMed
12.Huang, WT, Chen, TY, Su, WC, Yen, CJ, Tsao, CJ. Implantable venous port-related infections in cancer patients. Support Care Cancer 2004;12:197–201.CrossRefGoogle ScholarPubMed
13.Rello, J, Quintana, E, Mirelis, B, Gurgui, M, Net, A, Prats, G. Polymicrobial bacteremia in critically ill patients. Intensive Care Med 1993;19:22–25.CrossRefGoogle ScholarPubMed
14.Shmuely, H, Pitlik, S, Yahav, J, Samra, Z, Leibovici, L. Seven-year study of bacteremia in hospitalized patients on chronic hemodialysis in a single tertiary hospital. Ren Fail 2003;25:579–588.CrossRefGoogle Scholar
15.Bang, RL, Sharma, PN, Sanyal, SC, Bang, S, Ebrahim, MK. Burn septicaemia in Kuwait: associated demographic and clinical factors. Med Princ Pract 2004;13:136–141.CrossRefGoogle ScholarPubMed
16.Lortholary, O, Jehl, F, Petitjean, O, Cohen, P, Tarral, E, Guillevin, L. Polymicrobial pyomyositis and bacteremia in a patient with AIDS. Clin Infect Dis 1994;19:552–553.CrossRefGoogle Scholar
17.Price, CS, Hacek, D, Noskin, GA, Peterson, LR. An outbreak of bloodstream infections in an outpatient hemodialysis center. Infect Control Hosp Epidemiol 2002;23:713–715.CrossRefGoogle Scholar
18.Bizzarro, MJ, Raskind, C, Baltimore, RS, et al.Seventy-five years of neonatal sepsis at Yale: 1928–2003. Pediatrics 2005;116:595–602.CrossRefGoogle ScholarPubMed
19.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
20.Shennan, AT, Dunn, MS, Ohlsson, A, Lennox, K, Hoskins, EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988;82:527–532.CrossRefGoogle ScholarPubMed
21.Kliegman, RM, Walsh, MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987;17:213–288.Google ScholarPubMed
22.Bonadio, WA. Polymicrobial bacteremia in children: an 11-year experience. Am J Dis Child 1988;142:1158–1160.CrossRefGoogle Scholar
23.Trad, O, Jumaa, PA, Afify, Z. The changing pattern of bloodstream infection in pediatric oncology patients in the United Arab Emirates. Pediatr Hematol Oncol 2003;20:281–289.CrossRefGoogle ScholarPubMed
24.Clapp, DW. Developmental regulation of the immune system. Semin Perinatol 2006;30:69–72.CrossRefGoogle ScholarPubMed
25.McKenzie, FE. Case mortality in polymicrobial bloodstream infections. J Clin Epidemiol 2006;59:760–761.Google ScholarPubMed
26.Vales, EC, Abraira, V, Sanchez, JC, et al.A predictive model for mortality of bloodstream infections: bedside analysis with the Weibull function. J Clin Epidemiol 2002;55:563–572.CrossRefGoogle ScholarPubMed
27.Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in U.S. hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309–317.CrossRefGoogle Scholar