Abstract
Very little is known about laboratory-confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design and implement antibiotic stewardship policy and introduce interventions to reduce LCBIs in resource-limited settings.
Highlights
Health care-associated infections (HAIs) are a significant public health problem resulting in increased morbidity, mortality and increased hospital stay lengths and health care costs [1]
A total of 775 neonates were admitted in neonatal intensive care units (NICUs) during the study period and 150 neonates were suspected to have laboratory-confirmed blood stream infections (LCBIs)
A fourth (n = 41) of the babies were small for the gestational age (SGA), while the rest were appropriate for the gestational age (AGA); there were no large-for-the-gestational-age babies admitted in the unit during the study period
Summary
Health care-associated infections (HAIs) are a significant public health problem resulting in increased morbidity, mortality and increased hospital stay lengths and health care costs [1]. Neonates admitted to neonatal intensive care units (NICU) are more vulnerable to HAIs because of their underlying susceptibility, to infection and the need for invasive procedures [2]. Maternal and NICUs environmental factors contribute toward causing infections in newborns. Apart from the immature immune system, some of the fetal factors that predispose neonates to infections are: low birth weight, gestational age and Apgar score, prolonged hospital stay, invasive procedures, endotracheal tubes, umbilical cauterization, parenteral nutrition, lack of adequate hand washing by hospital personnel and indiscriminate use of antibiotics [1,2,3,4]. Diseases 2018, 6, 14 factors that predispose neonates to infections are: the premature rupture of membrane, maternal fever within two weeks prior to delivery, meconium-stained amniotic fluid (MSAF), foul smelling liquor and instrumental delivery, etc. NICUs environments can be bacteriologically very hostile, containing a wide selection of pathogenic, antibiotic resistant organisms with which the patient becomes colonized [1,2,3,4]
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