title: Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections.
abstract: OBJECTIVE
  To develop a candidate definition for central line-associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants.
  
  
  METHODS
  Multicenter retrospective cohort study.
  
  
  METHODS
  Neonatal intensive care units from 14 US children's hospitals and pediatric facilities.
  
  
  METHODS
  A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.
  
  
  RESULTS
  During 2009-2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).
  
  
  CONCLUSIONS
  While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.
authors.affiliation: Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, and Department of Infection Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Klieger
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Gail
authors.initials: G
authors.lastname: Potter-Bynoe
authors.forename: Bram
authors.initials: B
authors.lastname: Raphael
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Song
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
mesh_terms: D055499:Catheter-Related Infections / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D017144:Focus Groups; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009092:Mucous Membrane / Q000293:injuries*; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D012189:Retrospective Studies; D009626:Terminology as Topic