Abstract
BackgroundPolymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs. Very few studies have characterized polymicrobial bloodstream infections in the neonatal unit. Considerable variation has been reported in incidence of polymicrobial infections and associated clinical outcomes. We characterized the risk factors and outcomes of polymicrobial bloodstream infections in our neonatal units in a tertiary hospital in North America.MethodsIn a retrospective case control study design, we identified infants in the neonatal intensive care unit with positive blood cultures at Texas Children’s Hospital, over a 16-year period from January 1, 1997 to December 31, 2012. Clinical data from online databases were available from January 2009 to December 2012. For each polymicrobial bloodstream infection (case), we matched three infants with monomicrobial bloodstream infection (control) by gestational age and birth weight.ResultsWe identified 2007 episodes of bloodstream infections during the 16 year study period and 280 (14%) of these were polymicrobial. Coagulase-negative Staphylococcus, Enterococcus, Klebsiella and Candida were the most common microbial genera isolated from polymicrobial infections. Polymicrobial bloodstream infections were associated with more than 3-fold increase in mortality and an increase in duration of infection. Surgical intervention was a significant risk factor for polymicrobial infection.ConclusionThe frequency and increased mortality emphasizes the clinical significance of polymicrobial bloodstream infections in the neonatal intensive care unit. Clinical awareness and focused research on neonatal polymicrobial infections is urgently needed.
Highlights
Polymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs
We hypothesized that polymicrobial infections comprise > 5% of bloodstream infections in infants residing in the neonatal intensive care units, have identifiable risk factors and are associated with higher mortality and morbidity than monomicrobial infections
Identification of cases and controls We identified blood culture positive infants from the clinical microbiology database, who were admitted to the neonatal intensive care units (NICUs) III and II at Texas Children’s Hospital (TCH) from January 1, 1997 to December 31, 2012
Summary
Polymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs. Very few studies have characterized polymicrobial bloodstream infections in the neonatal unit. We characterized the risk factors and outcomes of polymicrobial bloodstream infections in our neonatal units in a tertiary hospital in North America. Polymicrobial infections increase mortality more than 2-fold in adults and children, increase length of hospital stay and healthcare costs [1,2]. Risk factors for polymicrobial infections in children and adults include the presence of a central venous catheter, administration of parenteral nutrition, gastrointestinal pathology, especially short gut syndrome, use of broad-spectrum antibiotics and immunosuppression [1,3,4]. Few studies have focused on polymicrobial infections in neonates, especially on risk factors and clinical outcomes in the western world [10,11,12]. A common risk factor appears to be multi-species biofilm infections originating from indwelling medical devices, notably indwelling vascular catheters or endotracheal tubes [1,17]
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