title: Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009-2011.
abstract: BACKGROUND
  Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011.
  
  
  METHODS
  The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS.
  
  
  RESULTS
  Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%).
  
  
  CONCLUSIONS
  Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.
authors.affiliation: Microbiology, Jagiellonian University Medical College, 18 Czysta Street, Krakow 31-121, Poland. mbmach@cyf-kr.edu.pl.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Wójkowska-Mach
authors.forename: Ewa
authors.initials: E
authors.lastname: Gulczyńska
authors.forename: Marek
authors.initials: M
authors.lastname: Nowiczewski
authors.forename: Maria
authors.initials: M
authors.lastname: Borszewska-Kornacka
authors.forename: Joanna
authors.initials: J
authors.lastname: Domańska
authors.forename: T Allen
authors.initials: TA
authors.lastname: Merritt
authors.forename: Ewa
authors.initials: E
authors.lastname: Helwich
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kordek
authors.forename: Dorota
authors.initials: D
authors.lastname: Pawlik
authors.forename: Janusz
authors.initials: J
authors.lastname: Gadzinowski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Szczapa
authors.forename: Paweł
authors.initials: P
authors.lastname: Adamski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sulik
authors.forename: Jerzy
authors.initials: J
authors.lastname: Klamka
authors.forename: Monika
authors.initials: M
authors.lastname: Brzychczy-Włoch
authors.forename: Piotr B
authors.initials: PB
authors.lastname: Heczko
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D009359:Neonatology; D011044:Poland; D012307:Risk Factors