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Epidemiology, risk factors, and applicability of CDC definitions for healthcare-associated bloodstream infections at a level IV neonatal ICU

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Abstract

Objectives

We studied the epidemiology of primary bloodstream infections (BSIs), secondary BSIs, and central line-associated BSIs (CLABSIs) and applicability of CDC definitions for primary sources of infection causing secondary BSIs in patients in the neonatal ICU.

Study design

We classified healthcare-associated BSIs (HABSIs) as primary BSIs, secondary BSIs, and CLABSIs using CDC surveillance definitions and determined their overall incidence and incidence among different gestational age strata. We assessed the applicability of CDC definitions for infection sources causing secondary BSIs.

Results

From 2010 to 2019, 141 (32.7%), 202 (46.9%), and 88 (20.4%) HABSIs were classified as primary BSIs, secondary BSIs, and CLABSIs, respectively; all declined during the study period (all p < 0.001). Gestational age <28 weeks was associated with increased incidence of all HABSI types. CDC criteria for site-specific primary sources were met in 137/202 (68%) secondary BSIs.

Conclusions

Primary and secondary BSIs were more common than CLABSIs and should be prioritized for prevention.

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Fig. 1: Incidence of total HABSIs, primary BSIs, secondary BSIs, and CLABSIs per 1000 admissions, 2010–2019.
Fig. 2: Association of chronologic age with primary BSIs, secondary BSIs, and CLABSIs, 2010-2019.
Fig. 3: Primary sources of secondary BSIs that met and did not meet full NHSN site-specific criteria, 2010–2019.
Fig. 4: Gestational age and chronologic age strata associated with meeting and not meeting full NHSN site-specific criteria for primary source, 2010–2019.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to privacy reasons relating to the sensitivity of the data collected but are available from the corresponding author on reasonable request and with the permission of the Columbia IRB and NewYork-Presbyterian Hospital.

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Acknowledgements

The authors would like to acknowledge the support received from the Divisions of Neonatology and Infectious Diseases in the Department of Pediatrics at Columbia University Irving Medical Center. We would also like to acknowledge Sonia Gollerkeri for her contributions to the statistical analyses.

Funding

AAP and IF were supported by the training grant “Training in Pediatric Infectious Diseases” (National Institute of Allergy and Infectious Diseases T32AI007531, PI: Saiman).

Author information

Author notes

  1. Kyra Solowey

    Present address: Department of Pediatrics, Children’s National Hospital, Washington, DC, USA

Authors and Affiliations

  1. Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA

    Anshu A. Paul, Eliza Gentzler, Kyra Solowey, Surya Manickam, Irene Frantzis, Luis Alba, Sandhya S. Brachio & Lisa Saiman

  2. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA

    Maria Messina & Lisa Saiman

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Contributions

LS was responsible for the conception of this project. AP, EG, KS, SM, IF, LA, SB, and LS were involved in the design and implementation. AP, EG, KS, SM, IF, and LA were responsible for acquisition of data and together with MM, SB, and LS analyzed and interpreted the data. AP was primarily responsible for writing the initial draft of the manuscript, which was edited by LS, SB, EG, and IF. All authors have reviewed the final manuscript.

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Correspondence to Lisa Saiman.

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Paul, A.A., Gentzler, E., Solowey, K. et al. Epidemiology, risk factors, and applicability of CDC definitions for healthcare-associated bloodstream infections at a level IV neonatal ICU. J Perinatol 43, 1152–1157 (2023). https://doi.org/10.1038/s41372-023-01728-y

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