Effects of nosocomial infection trends on neonatal outcomes in preterm infants <33 weeks of gestational age in Canadian NICUs
Caitlin Jantzen1, Abhay Lodha2, Mirea Lucia3, Shoo K Lee3, Xiang Y Ye3, Koravangattu Sankaran1
1. Department of Pediatrics, Royal University Hospital and College of Medicine, University of Saskatchewan, Saskatoon, Canada;
2. Department of Pediatrics and Community Health Sciences, University of Calgary;
3. Maternal and Infant Care Research Centre, Mount Sinai Hospital, University of Toronto, Canada
Abstract Objective To characterize recent trends of nosocomial infection (NI) among preterm infants admitted to Canadian Level 3 NICUs during 2008-2012, and its association with neonatal outcomes. Methods A retrospective observational cohort study was performed including infants born <33 weeks gestational age and admitted to 24 NICU sites participating in the Canadian Neonatal NetworkTM during 2008-2012. NICU sites were classified into three groups according to their baseline NI rates in 2008 [Low NI group (≤14%), Medium NI group (14.1%-19%) and High NI group (>19% )], and NICU sites were also classified according to their NI trend during 2008-2012 (decreased, null and increased). Trends in NI were further examined for each baseline-NI group. Trends for a composite outcome indicating mortality or severe morbidities (intraventricular hemorrhage grades ≥3 or periventricular leukomalacia, retinopathy of prematurity stages ≥3, bronchopulmonary dysplasia or necrotizing enterocolitis stages ≥2) were examined for each baseline-NI and trend-NI NICU site groups using multivariable logistic regression analyses adjusted for potential confounders. Results Baseline high NI group showed significantly decreased trends in NI rates, while for with medium or low baseline NI groups showed no significant trends in NI rates. The composite outcome (mortality during NICU stay or any severe neonatal morbidity such as intraventricular hemorrhage grades 3-4, periventricular leukomalacia, retinopathy of prematurity stages 3-5, bronchopulmonary dysplasia and necrotizing enterocolitis stages 2-3) decreased significantly for sites with decreased (OR=0.89, 95% CI=0.85-0.93) or null (OR=0.94, 95% CI=0.90-0.98) NI trends, but no significant trends in the composite outcome were detected for sites with increased NI rates. Conclusions The neonatal outcome is possibly influenced by NI rates and trend. The trend in the mortality and the risk of bronchopulmonary dysplasia, retinopathy of prematurity stage ≥3 and intraventricular hemorrhage >2 were significantly decreased for sites with decreased NI trend, suggesting that these improved outcomes may be associated with effort to decrease NI rate.
Caitlin Jantzen,Abhay Lodha,Mirea Lucia et al. Effects of nosocomial infection trends on neonatal outcomes in preterm infants <33 weeks of gestational age in Canadian NICUs[J]. CJCP, 2015, 17(10): 1019-1027.
Caitlin Jantzen,Abhay Lodha,Mirea Lucia et al. Effects of nosocomial infection trends on neonatal outcomes in preterm infants <33 weeks of gestational age in Canadian NICUs[J]. CJCP, 2015, 17(10): 1019-1027.
Carrieri MP, Stolfi I, Moro ML, et al. Intercenter variability and time of onset:two crucial issues in the analysis of risk factors for nosocomial sepsis[J]. Pediatr Infect Dis J, 2003, 22(7):599-609.
[2]
Moore DL. Nosocomial infections in newborn nurseries and neonatal intensive care units [M]//Hospital epidemiology and infection control. Williams & Wilkins, Baltimore;1996:535-564.
[3]
Kawagoe JY, Segre CAM, Pereira CR, et al. Risk factors for nosocomial infections in critically ill newborn:a 5-year prospective cohort study[J]. Am J Infect Control, 2001, 29(2):109-114.
[4]
Lee SK, McMillan D, Ohlsson A, et al. Variations in practice and outcomes of the Canadian NICU Network:1996-7[J]. Pediatrics, 2000, 106(5):1070-1079.
[5]
Chien LY, Macnab Y, Aziz K, et al. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units[J]. Pediatr Infect Dis J, 2002, 21(6):505-511.
[6]
Sohn AH, Garrett DO, Sinkowitz-Cochran RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients:results from the first national point-prevalence survey[J]. J Pediatr, 2001, 139(6):821-827.
[7]
Nagata E, Brito AS, Matsuo TL. Nosocomial infections in a neonatal intensive care unit:incidence and risk factors[J]. Am J Infect Control, 2002, 30(1):26-31.
[8]
Johnson TJ, Patel AL, Jegier BJ, et al. Cost of morbidities in very low birth weight infants[J]. J Pediatr, 2013, 162 (2):243-249.
[9]
Mwaniki MK, Atieno M, Lawn JE, et al. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults:a systematic review[J]. Lancet, 2012, 379(9814):445-452.
[10]
Rasigade JP, Raulin O, Picaud JC, et al. Methicillin-resistant Staphylococcus capitis with reduced vancomycin susceptibility causes late-onset sepsis in intensive care neonates[J]. PLoS One, 2012, 7(2):e31548.
[11]
Kirchhoff LV, Sheagren JN. Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus[J]. Infect Control, 1985, 6(12):479-486.
[12]
Kim SD, McDonald LC, Jarvis WR, et al. Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital:a role for species and strain identification[J]. Infect Control Hosp Epidemiol, 2000, 21(3):213-217.
[13]
Herwaldt LA, Geiss M, Kao C, et al. The positive predictive value of isolating coagulase-negative staphylococci from blood cultures[J]. Clin Infect Dis, 1996, 22(1):14-20.
[14]
Klingenberg C, Ronnestad A, Anderson AS, et al. Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit:virulence factors and invasiveness[J]. Clin Microbiol Infect, 2007, 13(11):1100-1111.
[15]
Ruhe J, Menon A, Mushatt D, et al. Non-epidermidis coagulasenegative staphylococcal bacteremia:clinical predictors of true bacteremia[J]. Eur J Clin Microbiol Infect Dis, 2004, 23(6):495-498.
[16]
Stoll B, Hansen N, Fanaroff A, et al. Late-onset sepsis in very low birth weight neonates:the experience of the NICHD Neonatal Research Network[J]. Pediatrics, 2002, 110(2 Pt 1):285-291.
[17]
Sohn A, Garrett D, Sinkowitz-Cochran R, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients:results from the first national point-prevalence survey[J]. J Pediatr, 2001, 139(6):821-827.
[18]
Shah PS, Yoon W, Kalapesi Z, et al. Seasonal variations in healthcare-associated infection in neonates in Canada[J]. Arch Dis Child Fetal Neonatal, 2013, 98(1):65-69.
[19]
Welliver RC, McLaughlin S. Unique epidemiology of nosocomial infections in a children's hospital[J]. Am J Dis Child, 1984, 138(2):131-135.
[20]
Harris JA. Pediatric nosocomial infections:children are not little adults[J]. Infect Control Hosp Epidemiol, 1997, 18(11):739-742.
[21]
Klinger G, Levy I, Sirota L, et al. Outcome of early-onset sepsis in a national cohort of very low birth weight infants[J]. Pediatrics, 2010, 125(4):e736-e740.