title: Surveillance of healthcare-associated infections in a neonatal intensive care unit in Italy during 2006-2010.
abstract: BACKGROUND
  Healthcare-associated infections (HAIs) are a frequent complication associated with hospitalization of infants in neonatal intensive care units (NICUs). The aim of this study was to evaluate and describe the results of surveillance of HAIs in a III level NICU in Naples, Italy during 2006-2010.
  
  
  METHODS
  The surveillance covered 1,699 neonates of all birth weight (BW) classes with >2 days NICU stay. Infections were defined using standard Centers for Disease Control and Prevention definitions adapted to neonatal pathology and were considered to be healthcare-associated if they developed >2 days after NICU admission.
  
  
  RESULTS
  One hundred-fifty-three HAIs were diagnosed with a frequency of 9% and an incidence density of 3.5 per 1000 days of hospital stay. HAIs developed in all BW classes, but patients weighing≤1000 g at birth were more affected with a decreasing trend from the lowest to the highest BW classes. Sepsis proved to be the most frequent infection (44.4%), followed by urinary tract infection (UTI) (28.8%), pneumonia (25.5%) and meningitis (1.3%). Device associated infections (i.e. central line-associated bloodstream infections (BSIs), umbilical catheter-associated BSI and ventilator associated pneumonias (VAPs) represented 64.1% of all HAIs. Most frequent pathogens responsible for all types of infections were: P. aeruginosa (17%), C. parapsilosis (16.3%), E. coli (13.1%), C. albicans (10.5%), non- extended spectrum beta-lactamase (ESBL) K. pneumoniae (7.8%), and coagulase-negative Staphylococci (5.2%). No microbiological diagnosis was achieved for 6.5% of infections.
  
  
  CONCLUSIONS
  HAIs developed in all BW classes but low BW neonates were at major risk to acquire HAIs in our NICU. Use of central line-, umbilical-catheter and mechanical ventilation was associated with higher risk of infection. Our findings highlight the importance of an extensive surveillance approach in the NICU setting, which includes all BW classes of neonates and monitors infections associated with the use of medical devices.
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. v.crivaro@virgilio.it.|AORN dei Colli, Monaldi Hospital, Via L. Bianchi, Naples, Italy. v.crivaro@virgilio.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Crivaro
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. 0lilu0@libero.it.
authors.forename: Lidija
authors.initials: L
authors.lastname: Bogdanović
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. maria.bagattini@unina.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Bagattini
authors.affiliation: Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy. dora.iula@gmail.com.
authors.forename: Vita Dora
authors.initials: VD
authors.lastname: Iula
authors.affiliation: Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy. mariarosaria.catania@unina.it.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Catania
authors.affiliation: Division of Neonatology, Department of Medical Translational Sciences, University of Naples "Federico II", Naples, Italy. francesco.raimondi@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. triassi@unina.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. rafzarri@unina.it.|Italian Study Group of Hospital Hygiene, Italian Society of Hygiene, Preventive Medicine and Public Health, (GISIO), Rome, Italy. rafzarri@unina.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Zarrilli
mesh_terms: D001724:Birth Weight; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control