title: Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006-2008.
abstract: OBJECTIVE
  To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (children's vs general hospitals).
  
  
  METHODS
  Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008.
  
  
  METHODS
  We analyzed central line-associated bloodstream infections (CLABSIs), umbilical catheter-associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used.
  
  
  RESULTS
  Pooled mean incidence rates by birth weight category (750 g or less, 751-1,000 g, 1,001-1,500 g, 1,501-2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in children's hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant.
  
  
  CONCLUSIONS
  Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between children's and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. shocevar@cdc.gov
authors.forename: Susan N
authors.initials: SN
authors.lastname: Hocevar
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Horan
authors.forename: Gloria C
authors.initials: GC
authors.lastname: Morrell
authors.forename: Martha
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001724:Birth Weight; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology; D006769:Hospitals, General / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data*; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D014471:Umbilical Veins; D014481:United States / Q000453:epidemiology; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology