title: Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.
abstract: BACKGROUND
  Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce.
  
  
  OBJECTIVE
  To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.
  
  
  METHODS
  This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences.
  
  
  RESULTS
  During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041).
  
  
  CONCLUSIONS
  Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil. Electronic address: rmcromanelli@ig.com.br.
authors.forename: Roberta Maia de Castro
authors.initials: RM
authors.lastname: Romanelli
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Lêni Márcia
authors.initials: LM
authors.lastname: Anchieta
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Elaine Alvarenga de Almeida
authors.initials: EA
authors.lastname: Carvalho
authors.affiliation: Pediatrics Infectious Diseases, Hospital Infantil João Paulo II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Lorena Ferreira de
authors.initials: LF
authors.lastname: Glória e Silva
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Rafael Viana Pessoa
authors.initials: RV
authors.lastname: Nunes
authors.affiliation: Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil.
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Mourão
authors.affiliation: Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil; Department of Complementary Propedeutics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Wanessa Trindade
authors.initials: WT
authors.lastname: Clemente
authors.affiliation: Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Maria Cândida Ferrarez
authors.initials: MC
authors.lastname: Bouzada
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
keywords: Infection control; Newborn intensive care units; Sepsis; Surgery