Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011): trends in incidence, pathogens, and mortality.
OBJECTIVE
To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011).


METHODS
Historical cohort study.


METHODS
Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital.


METHODS
Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD).


METHODS
A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis.


RESULTS
In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001).


CONCLUSIONS
An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.
Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
Evelien
E
Verstraete
Jerina
J
Boelens
Kris
K
De Coen
Geert
G
Claeys
Dirk
D
Vogelaers
Piet
P
Vanhaesebrouck
Stijn
S
Blot
D001530:Belgium / Q000453:epidemiology; D002243:Carbolines; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality
D002243:Carbolines; C025079:diazoline