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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 (caroline.quach@mcgill.ca).
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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 

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Footnotes

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

a

Primary coauthors with equal contribution.

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