Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections.

TitleCentral line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections.
Publication TypeJournal Article
Year of Publication2014
AuthorsCoffin SE, Klieger SB, Duggan C, W Huskins C, Milstone AM, Potter-Bynoe G, Raphael B, Sandora TJ, Song X, Zerr DM, Lee GM
Corporate AuthorsPediatric Prevention EpiCenter Consortium
JournalInfect Control Hosp Epidemiol
Volume35
Issue11
Pagination1391-9
Date Published2014 Nov
ISSN1559-6834
Abstract

OBJECTIVE: To develop a candidate definition for central line-associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants.

DESIGN: Multicenter retrospective cohort study.

SETTING: Neonatal intensive care units from 14 US children's hospitals and pediatric facilities.

METHODS: A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.

RESULTS: During 2009-2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).

CONCLUSIONS: While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.

DOI10.1086/678410
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID25333434
PubMed Central IDPMC4551075
Grant ListK24 HD058795 / HD / NICHD NIH HHS / United States
K24HD058795 / HD / NICHD NIH HHS / United States
U54-CK000163 / CK / NCEZID CDC HHS / United States