Bloodstream Infections In Neonatal Intensive Care Unit Research Articles

Infection prevention practices in neonatal intensive care units reporting to the national healthcare safety network.

Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections. Variability in reported infection rates among NICUs exists, possibly related to differences in prevention strategies. A better understanding of current prevention practices may help identify prevention gaps and areas for further research. We surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network (NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and central line-associated bloodstream infections in NICUs. Staff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central line insertion and maintenance bundles, but maintenance practices varied, including agents used for antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs (51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no restrictions. Our survey illustrated heterogeneity of CLABSI and MRSA prevention practices and underscores the need for further research to define optimal strategies and evidence-based prevention recommendations for neonates.

Bloodstream infections and antimicrobial resistance patterns in a South African neonatal intensive care unit

Background:Bloodstream infections remain a leading cause of morbidity and mortality in neonatal intensive care units (NICU) worldwide. Commonly isolated NICU pathogens are increasingly resistant to standard antimicrobial treatment regimes.Objectives:The primary aim of this study was to determine the burden of bloodstream infections (BSI) in an NICU in a low-to-middle-income country and to describe the spectrum of pathogens isolated together with their drug susceptibility patterns.Methods:This retrospective, descriptive study included NICU patients admitted to the Tygerberg Children’s Hospital, Cape Town, between 1 January and 31 December 2008. All blood culture samples submitted to the reference laboratory were extracted and clinical data on patients were obtained by hospital record review.Results:There were 78 culture-confirmed episodes of BSI in 54/503 (11%) patients admitted; median gestational age was 31 weeks (IQR 29–37) and birth weight 1370 g (IQR 1040–2320). Common isolates included coagulase-negative Staphylococcus (22/78, 28%), Klebsiella spp. (17/78, 22%), Acinetobacter spp. (14/78, 18%), Candida spp. (9/78, 11·5%) and methicillin-resistant Staphylococcus aureus (5/78, 6%). There was a predominance of gram-negative organisms (38/78, 48·7%). All Staphylococcus aureus isolates were methicillin-resistant and 59% of Klebsiella pneumoniae isolates were extended spectrum β-lactamase (ESBL) producers. Acinetobacter baumanii isolates showed low susceptibility to the aminoglycosides, carbapenems and cephalosporins. Of 54 infants admitted to the NICU with BSI, 25 (46%) died; 9/25 deaths (36%) were attributable solely to infection.Conclusion:Compared with overall mortality in the NICU, that attributable solely or partly to BSI was high. Many bacterial BSI isolates were resistant to current empiric antibiotic regimens. Regular microbiological and clinical surveillance of BSI in NICUs is required to inform appropriate antibiotic protocols and monitor the impact of infection prevention strategies.

English

BACKGROUND: Hospital acquired bloodstream infections (BSI) are important cause of morbidity and mortality in Neonatal Intensive Care Unit (NICU) as well as of prolonged hospitalization and additional costs. AIM: The present study was performed to determine the incidence rate and incidence density of hospital acquired BSI in NICU along with their microbiological profile and sensitivity pattern. SETTINGS AND DESIGN: The study was conducted prospectively from 1 st May 2009 to 30 th June 2010, in the NICU at a tertiary care hospital in Gujarat. METHODS AND MATERIAL: Hospital acquired BSIs were identified according to National Nosocomial Infection Surveillance System (NNIS) definition. The incidence rate was calculated as BSIs per 100 admissions, and incidence density was calculated as BSIs per 1000 patient-days and 1000 central line-days. RESULTS: During the study period 626 neonates were admitted in NICU out of which 40 neonates were positive for hospital acquired BSI with incidence rate of 6.38 per 100 admissions and incidence density of 22.64 per 1000 patient-days. Central line-associated BSI (CLABSI) rate was 57.14 per 1000 central line- days. Klebsiella pneumoniae (67.5%) was the predominant isolate with all strains being ESBL producers. CONCLUSIONS: Hospital acquired BSIs in NICU was identified as a significant problem reflecting a need for strict implementation of preventive measures. Inadequate staffing has also been observed in the present study as a predisposing factor to the nosocomial BSIs. KEY-WORDS: Hospital acquired infections, Bloodstream Infections, Neonates, Intramural, Extramural, Central line. KEY MESSAGES: Surveillance data are crucial and should become an important component of hospital infection control program in NICU as it provides an overview of our infection control practices. INTRODUCTION: Patients treated in Neonatal Intensive Care Units (NICUs) are at highest risk for Hospital Acquired Infections (HAIs) 1 and bloodstream infections (BSIs) are most common in these settings. 2, 3 Surveillance of Hospital Acquired BSIs has proved to be an essential component in infection control and by determining the baseline HAI rates, changes in the rates can be detected and timely measures can be introduced thereby reducing HAI rates, mortality, morbidity and cost. 4 The purpose of this study was to determine the Hospital Acquired BSIs in

Prévention des septicémies nosocomiales sur cathéters veineux centraux dans une unité de réanimation néonatale : impact d'une procédure d'information

Objective Few studies have evaluated the impact of an information and prevention process specifically aimed at neonatalogists and nurses working in a neonatal intensive care unit (NICU) towards the prophylaxis of nosocomial bloodstream infections. Our objective was first to analyze nosocomial infections within our unit, and secondly to evaluate the impact of a monthly report providing information related to the number and characteristics of such infections. Participants and methods A prospective study was performed in the NICU of Angers University Hospital during 2 six-month periods. All cases of nosocomial bloodstream infections and their characteristics were analyzed. We then published a nosocomial infections report every month during the second period, in order to inform the medical staff and nurses of the results. The impact of the information and prevention process was evaluated by comparing the results between the 2 periods. We also assessed the staff's interest by questionnaire. Results Two hundred and fifty-four (first period) and 240 (second period) patients were included. A decrease in the specific incidence rate and density of catheter related bloodstream infections was observed between the 2 periods, especially for preterms with a birth weight < 1000 g and gestational age < 28 SA ( P < 0.01). Coagulase negative Staphylococcus was identified in 82.3% and 62.5% of cases respectively. 54% of the members of staff expressed their concerns related to the findings and were very interested to read about the observations made during the study. Conclusion This original process seems to be both effective and inexpensive, and can be easily reproduced to decrease the frequency of bloodstream infections in NICU. However, its long-term impact still needs to be evaluated.

Elucidating the origins of nosocomial infections with Candida albicans by DNA fingerprinting with the complex probe Ca3.

Computer-assisted DNA fingerprinting with the complex probe Ca3 has been used to analyze the relatedness of isolates collected from individuals with nosocomial bloodstream infections (BSIs) and hospital care workers (HCWs) in the surgical and neonatal intensive care units (ICUs) of four hospitals. The results demonstrate that for the majority of patients (90%), isolates collected from commensal sites before and after collection of a BSI isolate were highly similar or identical to the BSI isolate. In addition, the average similarity coefficient for BSI isolates was similar to that for unrelated control isolates. However, the cluster characteristics of BSI isolates in dendrograms generated for each hospital compared to those of unrelated control isolates in a dendrogram demonstrated a higher degree of clustering of the former. In addition, a higher degree of clustering was observed in mixed dendrograms for HCV isolates and BSI isolates for each of the four test hospitals. In most cases, HCW isolates from an ICU were collected after the related BSI isolate, but in a few cases, the reverse was true. Although the results demonstrate that single, dominant endemic strains are not responsible for nosocomial BSIs in neonatal ICUs and surgical ICUs, they suggest that multiple endemic strains may be responsible for a significant number of cases. The results also suggest that cross-contamination occurs between patients and HCWs and between HCWs in the same ICU and in different ICUs. The temporal sequence of isolation also suggests that in the majority of cases HCWs are contaminated by isolates from colonized patients, but in a significant minority, the reverse is true. The results of this study provide the framework for a strategy for more definitive testing of the origins of Candida albicans strains responsible for nosocomial infections.