Major Article
Risk factors for late-onset health care–associated bloodstream infections in patients in neonatal intensive care units

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Background

There are few data comparing risk factors for catheter-related (CR) versus non-CR bloodstream infection (BSI) or for BSI caused by gram-positive versus gram-negative organisms. The aims of this study were to compare risk factors for CR versus non-CR BSI and to compare risk factors for BSI associated with gram-negative versus gram-positive organisms among infants hospitalized in two neonatal intensive care units (NICUs).

Methods

Data were collected prospectively over a 2-year period to assess risk factors among 2,935 neonates from two NICUs.

Results

Among all neonates, in addition to low birth weight and presence of a central venous catheter, hospitalization in NICU 1 (relative risk [RR]: 1.60, 95% confidence intervals [CI]: 1.14, 2.24) was a significant predictor of BSI. In neonates with a central catheter total parenteral nutrition (TPN) was a significant risk factor for BSI (RR: 4.69, 95% CI: 2.22, 9.87). Ventilator use was a significant risk factor for CR versus non-CR BSI (RR: 3.74, 95% CI: 1.87, 7.48), and significantly more CR BSI were caused by gram-positive (77.1%) than by gram-negative organisms (61.4%), P = .03.

Conclusions

This study confirmed that central venous catheters and low birth weight were risk factors for neonates with late-onset healthcare-associated BSI and further elucidated the potential risks associated with TPN and ventilator use in subgroups of neonates with BSI. Additional studies are needed to examine the incremental risk of TPN among infants with central venous catheters and to understand the link between CR BSI and ventilator use. Preventive strategies for BSI in neonates in NICUs should continue to focus on limiting the use of invasive devices.

Section snippets

Sample and setting

This study was 1 component of a larger prospective trial to assess the effect of staff hand hygiene on HAI in neonates performed in 2 NICUs from March 2001 through January 2003.10 During the study, either a traditional antiseptic soap containing 2% chlorhexidine gluconate or a waterless hand rinse containing 60% ethyl alcohol was used by all staff and visitors sequentially for half of the study period (11 months for each product) in a randomly assigned crossover design; no significant

Results

The characteristics of neonates with and without a health care-associated BSI are summarized in Table 1. In all, 2935 neonates were included in this study. Of these, 205 (7.0%) developed a bacterial BSI. The mean age of neonates at the time of the first health care-associated BSI was 21.4 days in NICU 1 and 35.7 days in NICU 2. Eighteen percent of neonates developed their first bacterial BSI after 30 days of life. Rates of BSI by unit were 18.5/1000 catheter days in NICU 1 and 13.0/1000

Discussion

This is one of the largest studies to assess prospectively the risk factors for late-onset health care-associated BSI in the NICU population. Not surprisingly, we found that central venous catheters and lower birth weight placed infants at a higher risk of developing bacterial BSI, as has been shown in other studies.6, 7, 8, 13, 14 We also noted that study site was a significant predictor of BSI, even after controlling for differences in birth weight. Although neonates in NICU 2 had a longer

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    Supported by grant 5 RO1 NR05197 from the National Institutes of Health National Institute for Nursing Research, Bethesda, MD.

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