title: Validation of nosocomial infection in neonatology: a new method for standardized surveillance.
abstract: BACKGROUND
  Nosocomial infections (NIs) are a leading cause of mortality and morbidity in premature infants. We present a new method for detecting and confirming NIs in a neonatal intensive care unit.
  
  
  METHODS
  Newborns with birth weight < 1,500 g or gestational age (GA) < 33 weeks were included prospectively over 2 years in a single-center tertiary neonatal intensive care unit. The computerized physician order entry system (CPOE) generated alerts when antibiotics were prescribed for at least 5 consecutive days and these cases were reviewed by an expert group following international recommendations.
  
  
  RESULTS
  Four hundred sixty-one neonates were included, with a mean GA of 30 weeks (range, 26-32 weeks) and mean birth weight 1,270 g (range, 950-1600 g). The CPOE flagged 158 cases of potential NI, 85.1% of which were classified as true NI and 14.9% of which were false positive. Incidence and device-associated nosocomial bloodstream infection rates were 21.9% and 10.8 per 1,000 central venous catheter days, respectively. GA ≤ 28 weeks (odds ratio, 2.18; 95% confidence interval, 1.2-4) and > 7 central venous catheter days (odds ratio, 1.47; 95% confidence interval, 1.3-1.7) were independently associated with the risk of nosocomial bloodstream infection.
  
  
  CONCLUSIONS
  Combining CPOE and interdisciplinary review may improve the accuracy of NI recording in a neonatal intensive care unit.
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Durand
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Rideau Batista Novais
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mesnage
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Combes
authors.affiliation: Department of Bacteriology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Didelot
authors.affiliation: Department of Hospital Infection Control, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lotthé
authors.affiliation: Department of Pediatrics, Nîmes University Hospital Center, Nîmes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Filleron
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Baleine
authors.affiliation: Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France. Electronic address: g-cambonie@chu-montpellier.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology*; D004363:Drug Utilization; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems; D009359:Neonatology / Q000379:methods*; D011446:Prospective Studies; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheter-related infection; Computerized physician order entry; Epidemiologic surveillance; Interdisciplinary communication; Premature infants