Analysis of Central Line-associated Bloodstream Infection among Infants in the Neonatal Intensive Care Unit: A Single Center Study
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.
Abstract
Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.
참고문헌 (29)
- Menon G, "Neonatal long lines", Arch Dis Child Fetal Neonatal Ed, 88, pp.F260~F262 (2003)
- Erdei C, "Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective", Pediatrics, 135, pp.e1485~e1493 (2015)
- Goudie A, "Attributable cost and length of stay for central line-associated bloodstream infections", Pediatrics, 133, pp.e1525~e1532 (2014)
- Karagiannidou S, "Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece", J Infect Public Health, 12, pp.372~379 (2019)
- Couto RC, "A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units", Am J Infect Control, 35, pp.183~189 (2007)
- Sengupta A, "Catheter duration and risk of CLA-BSI in neonates with PICCs", Pediatrics, 125, pp.648~653 (2010)
- Milstone AM, "Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study", Pediatrics, 132, pp.e1609~e1615 (2013)
- Sanderson E, "NICUS Network. Dwell time and risk of central-line-associated bloodstream infection in neonates", J Hosp Infect, 97, pp.267~274 (2017)
- Greenberg RG, "Effect of catheter dwell time on risk of central line-associated bloodstream infection in infants", Pediatrics, 136, pp.1080~1086 (2015)
- American Academy of Pediatrics Committee on Fetus and Newborn, "Levels of neonatal care", Pediatrics, 130, pp.587~597 (2012)
- Kwak YG, "Risk factors for device-associated infection related to organisational characteristics of intensive care units: findings from the Korean Nosocomial Infections Surveillance System", J Hosp Infect, 75, pp.195~199 (2010)
- Huebner J, "Coagulase-negative staphylococci: role as pathogens", Annu Rev Med, 50, pp.223~236 (1999)
- Lake JG, "Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011–2014", Infect Control Hosp Epidemiol, 39, pp.1~11 (2018)
- Hsu JF, "Risk factors of catheter-related bloodstream infection with percutaneously inserted central venous catheters in very low birth weight infants: a center's experience in Taiwan", Pediatr Neonatol, 51, pp.336~342 (2010)
- 천베드로, "최근 6년간 단일 신생아중환자실에서 발생한 패혈증 환자의 분석", Clinical and Experimental Pediatrics, 53(4), pp.495~502 (2010), 대한소아청소년과학회
- Schulman J, "Neonatal intensive care unit antibiotic use", Pediatrics, 135, pp.826~833 (2015)
- Patel SJ, "Gram-negative bacilli in infants hospitalized in the neonatal intensive care unit", J Pediatric Infect Dis Soc, 6, pp.227~230 (2017)
- Almuneef MA, "Molecular typing demonstrating transmission of Gram-negative rods in a neonatal intensive care unit in the absence of a recognized epidemic", Clin Infect Dis, 32, pp.220~227 (2001)
- Folgori L, "The relationship between Gram-negative colonization and bloodstream infections in neonates: a systematic review and meta-analysis", Clin Microbiol Infect, 24, pp.251~257 (2018)
- Stoll BJ, "Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network", Pediatrics, 110, pp.285~291 (2002)
- Gullberg E, "Selection of resistant bacteria at very low antibiotic concentrations", PLoS Pathog, 7, pp.e1002158~ (2011)
- Benjamin DK Jr, "Neonatal candidiasis: epidemiology, risk factors, and clinical judgment", Pediatrics, 126, pp.e865~e873 (2010)
- Hanna Pharm M, "Which patient in the neonatal intensive care unit should receive antifungal prophylaxis therapy?", Isr Med Assoc J, 23, pp.116~120 (2021)
- O'Grady NP, "Guidelines for the prevention of intravascular catheter-related infections", Clin Infect Dis, 52, pp.e162~e193 (2011)
- Chien LY, "Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units", Pediatr Infect Dis J, 21, pp.505~511 (2002)
- Hoang V, "Percutaneously inserted central catheter for total parenteral nutrition in neonates: complications rates related to upper versus lower extremity insertion", Pediatrics, 121, pp.e1152~e1159 (2008)
- Perlman SE, "Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units", Am J Infect Control, 35, pp.177~182 (2007)
- Mermel LA, "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America", Clin Infect Dis, 49, pp.1~45 (2009)
- Marschall J, "Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update", Infect Control Hosp Epidemiol, 35(Suppl 2), pp.S89~S107 (2014)