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Determinants of Nosocomial Infection in 6 Neonatal Intensive Care Units: An Italian Multicenter Prospective Cohort Study

Published online by Cambridge University Press:  02 January 2015

Cinzia Auriti ,
Maria Paola Ronchetti ,
Patrizio Pezzotti ,
Gabriella Marrocco ,
Anna Quondamcarlo ,
Giulio Seganti ,
Francesco Bagnoli ,
Claudio De Felice ,
Giuseppe Buonocore  and
Cesare Arioni
...Show all authors
Cinzia Auriti*
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Maria Paola Ronchetti
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Patrizio Pezzotti
Affiliation:
Agency for Public Health, Lazio, Rome
Gabriella Marrocco
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Anna Quondamcarlo
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Giulio Seganti
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Francesco Bagnoli
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Claudio De Felice
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Giuseppe Buonocore
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Cesare Arioni
Affiliation:
Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Giovanni Serra
Affiliation:
Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Gianfranco Bacolla
Affiliation:
Department of Neonatology and Neonatal Intensive Care, Burlo Garofalo Institute, IRCCS, Trieste
Giovanna Corso
Affiliation:
Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
Savino Mastropasqua
Affiliation:
Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
Annibale Mari
Affiliation:
Neonatal Intensive Care Unit, General Hospital, Cosenza, Italy
Carlo Corchia
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Domenico Di Lallo
Affiliation:
Agency for Public Health, Lazio, Rome
Lucilla Ravà
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Marcello Orzalesi
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Vincenzo Di Ciommo
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
*
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S. Onofrio, 4, 00165 Rome, Italy (cinzia.auriti@opbg.net)
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Abstract

Background.

Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs).

Objective.

To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection.

Design.

A multicenter, prospective cohort study.

Patients and Setting.

A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay.

Methods.

Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated.

Results.

A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95% CI, 1.5-3.5]).

Conclusions.

Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 9 , September 2010 , pp. 926 - 933
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1. Goldmann, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal care unit. J Infect Dis 1981;144:449–459.Google Scholar
2. Goldmann, DA, Freeman, J, Durbin, WA Jr. Nosocomial infection and death in a NICU. J Infect Dis 1983;147:635–641.Google Scholar
3. Moro, ML, De Giacomi, GV, Greco, D. Le infezioni ospedaliere in neonatologia. Riv InfPed 1987;4:239–250.Google Scholar
4. Stolli, I, Moro, ML, Lana, S. Frequenza e variabilità delle infezioni ospedaliere in terapia intensiva neonatale. Riv Ital Pediatr 1999;25:193–197.Google Scholar
5. Kawagoe, JY, Segre, CA, Pereira, CR, et al. Risk factors for nosocomial infections in critically ill newborns: a 5 year prospective cohort study. Am J Infect Control 2001;29:109–114.CrossRefGoogle ScholarPubMed
6. Stoll, BJ, Gordon, T, Korones, SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:63–67.Google Scholar
7. Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.Google Scholar
8. Gray, JE, Richardson, DK, McCormick, MC, Goldmann, DA. Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relations to admission illness severity. Pediatrics 1995;95:225–230.CrossRefGoogle ScholarPubMed
9. Mullet, MD, Cook, EF, Gallagher, R. Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 1998;18:112–115.Google Scholar
10. Makhoul, IR, Sujov, P, Smolkin, T, Lusky, A, Reichman, B. Epidemiological, clinical and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics 2002;109:34–39.Google Scholar
11. Mahieu, LM, De Dooy, JJ, Lenaerts, AE, leven, MM, De Muynck, AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001;48:20–26.CrossRefGoogle ScholarPubMed
12. Ferguson, JK, Gill, A. Risk-stratified nosocomial infection surveillance in a neonatal intensive care unit: report on 24 months of surveillance. J Paediatr Child Health 1996;32:525–531.CrossRefGoogle Scholar
13. Moro, ML, De Toni, A, Stolfi, I, Carrieri, MP, Braga, M, Zunin, C. Risk factors for nosocomial sepsis in newborn intensive and intermediate care units. Eur J Pediatr 1996;155:315–322.Google Scholar
14. Auriti, C, Maccallini, A, Di Liso, G, Di Ciommo, V, Ronchetti, MP, Orzalesi, M. Risk factors for nosocomial infections in a neonatal intensive care unit. J Hosp Infect 2003;53:25–30.CrossRefGoogle Scholar
15. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-June 2001, issued August 2001 Am J Infect Control 2001;29:404–421.Google Scholar
16. Carrieri, MP, Stolfi, I, Moro, ML. Intercenter variability and time of onset: two crucial issues in the analysis of risk factors for nosocomial sepsis. Pediatr Infect Dis J 2003;22:599–609.Google Scholar
17. de Irala-Estévez, J, Martínez-Concha, D, Díaz-Molina, C, Masa-Calles, J, Serrano del Casillo, A, Femández-Crehuet Navajas, R. Comparison of different methodological approaches to identify risk factors of nosocomial infection in intensive care units. Intensive Care Med 2001;27:1254–1262.CrossRefGoogle ScholarPubMed
18. Olsen, AL, Reinholdt, J, Jensen, AM, Andersen, LP, Jensen, ET. Nosocomial infection in a Danish neonatal intensive care unit: a prospective study. Acta Paediatr 2009;98:1294–1299.CrossRefGoogle Scholar
19. Smith, DW. Recognizable patterns of human malformation. Major Probi Clin Pediatr 1982;7:16–53.Google ScholarPubMed
20. Fowlie, PW, Gould, CR, Parry, GJ, et al. CRIB (clinical risk index for babies) in relation to nosocomial bacteremia in very low birthweight or preterm infants. Arch Dis Fetal Neonatal Ed 1996;75:F49–F52.Google Scholar
21. Richardson, DK, Tarnow-Mordi, WO, Escobar, GJ. Neonatal risk scoring systems. Can they predict mortality and morbidity? Clin Perinatol 1998;25:591–611.Google Scholar
22. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
23. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection:2009 update by the Infectious Diseases Society of America [published corrections appear in Clin Infect Dis 2010;50(7):1079 and Clin Infect Dis 2010;50(3):457]. Clin Infect Dis 2009;49(1):1–45.Google Scholar
24. Wei, LJ, Lin, DY, Weissfeld, L. Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. J Am Stat Assoc 1989;84:1065–1073.Google Scholar
25. van der Zwet, WC, Kaiser, AM, van Elburg, RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005;61:300–311.CrossRefGoogle Scholar
26. Urrea, M, Iriondo, M, Thio, M, et al. A prospective incidence study of nosocomial infections in a neonatal care unit. Am J Infect Control 2003;31:505–507.Google Scholar
27. Mullet, MD, Cook, EF, Gallagher, R. Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 1998;18:112–115.Google Scholar
28. Suara, RO, Young, M, Reeves, I. Risk factors for nosocomial infection in a high-risk nursery. Infect Control Hosp Epidemiol 2000;21:250–251.Google Scholar
29. Brodie, SB, Sands, KE, Gray, JE, et al. Occurrence of nosocomial bloodstream infection in six neonatal intensive care units. Pediatr Infect Dis J 2000;19:56–65.CrossRefGoogle ScholarPubMed
30. Freeman, J, Platt, R, Epstein, MF, Smith, NE, Sidebottom, DG, Goldmann, DA. Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care units: potential for confounding. Am J Epidemiol 1990;132:1130–1140.CrossRefGoogle ScholarPubMed
31. Avila Figueroa, C, Goldmann, DA, Richardson, DK, Gray, JE, Ferrari, A, Freeman, J. Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns. Pediatr Infect Dis J 1998;17:10–17.Google Scholar
32. Holmes, A, Dore, CJ, Saraswatula, A, et al. Risk factors and recommendations for rate stratification for surveillance of neonatal healthcare-associated bloodstream infection. J Hosp Infect 2008;68:66–72.CrossRefGoogle ScholarPubMed
33. Freeman, J, Goldmann, DA, Smith, NE, Sidebottom, DG, Epstein, MF, Platt, R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 1990;323:301–308.Google Scholar
34. Andersen, C, Hart, J, Vemgal, P, Harrison, C. Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants. J Hosp Infect 2005;61:162–167.Google Scholar
35. Horbar, JD, Rogowsky, J, Plsek, PE, et al. Collaborative quality improvement for neonatal intensive care. Pediatrics 2001;107:14–22.Google Scholar
36. Frakking, FNJ, Brouwer, N, van Eijkelenburg, NKA, et al. Low mannose-binding lectin (MBL) levels in neonates with pneumonia and sepsis. Clin Exp Immunol 2007;150:255–262.Google Scholar