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Trivedi A, Maheshwari R, Tarnow-Mordi WO, Saxena N. Lactoferrin for the postoperative management of term neonates after gastrointestinal surgery. Cochrane Database Syst Rev 2023; 5:CD012218. [PMID: 37233609 PMCID: PMC10215284 DOI: 10.1002/14651858.cd012218.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Neonates who have undergone gastrointestinal surgery are particularly susceptible to infectious complications in the postoperative period. This may be due in part to disruption of the integrity of the gut and its altered intestinal microflora. Lactoferrin is a whey protein found in milk and is an important innate mammalian defence mechanism. Lactoferrin has been reported to have antimicrobial and anti-inflammatory properties. It has also been reported to help establish a healthy gut microflora and aid in the intestinal immune system. Lactoferrin supplementation has been reported to decrease sepsis in preterm infants. There may be a role for lactoferrin to reduce the incidence of sepsis, thus reducing morbidity and mortality and improving enteral feeding in postoperative term neonates. OBJECTIVES The primary objective of this review was to evaluate the efficacy of administering lactoferrin on the incidence of sepsis and mortality in term neonates after gastrointestinal surgery. The secondary objective was to assess the impact of administering lactoferrin on time to full enteral feeds, the intestinal microflora, duration of hospital stay, and mortality before discharge in the same population. SEARCH METHODS The Cochrane Neonatal Information Specialist searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase Ovid, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. The date of the last search was February 2023. There were no restrictions to language, publication year or publication type. We checked references of potentially relevant studies and systematic reviews. SELECTION CRITERIA We planned to include randomised controlled trials that studied infants born at 37 or more weeks of gestation who had one or more episodes of gastrointestinal surgery within 28 days of birth, and compared administration of lactoferrin with a placebo. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We planned to use the GRADE approach to assess the certainty of evidence for each outcome. MAIN RESULTS We identified no published randomised controlled studies that assessed the efficacy of lactoferrin for the postoperative management of term neonates following gastrointestinal surgery. AUTHORS' CONCLUSIONS There is currently no evidence available from randomised controlled trials to show whether lactoferrin is effective or ineffective for the postoperative management of term neonates after gastrointestinal surgery. There is a need for randomised controlled trials to be performed to assess the role of lactoferrin in this setting.
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Affiliation(s)
- Amit Trivedi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, Australia
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Yu YQ, He XR, Wan LJ, Yang YH, Chen PY. Etiology, antimicrobial resistance, and risk factors of neonatal sepsis in China: a systematic review and meta-analysis from data of 30 years. J Matern Fetal Neonatal Med 2021; 35:7541-7550. [PMID: 34470123 DOI: 10.1080/14767058.2021.1951217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the regional etiology, antimicrobial resistance (AMR) pattern, and risk factors in neonates with sepsis in China. METHODS We performed a systematic review and meta-analysis by searching Medline, Embase, Scopus, and Web of Science in December 2020. Studies of neonatal sepsis from China published between 2011 and 2020 were included. We pooled the proportion of pathogens and calculated the odds ratios of risk factors with 95% CIs using a random-effects model. RESULTS We included 29 studies of 164,750 neonates with sepsis. The studies comprise data from 1990 to 2019. Coagulase-negative staphylococci (CoNS), Escherichia coli and Klebsiella spp accounted for 33% (95% CI 24-43), 17% (13-20), and 14% (11-17), respectively. Group B streptococcus (GBS) was the predominant isolate in early-onset sepsis (EOS) (21%, 95% CI 10-31), while the proportion of CoNS was the largest in late-onset sepsis (LOS) (32%, 95% CI 22-43). Resistance of CoNS to penicillin was found in 95% (95% CI 92-98) of 511 cases and Klebsiella spp to ampicillin in 95% (95% CI 90-99) of 364 cases. Maternal underlying diseases (2.61, 95% CI 1.48-4.61), mechanical ventilation (2.41, 1.37-4.23), central venous catheter placement (2.74, 1.77-4.26), peripherally inserted central catheter (PICC) placement (4.26, 2.80-6.49), multiple antibiotic uses (5.35, 1.85-15.43) and total parenteral nutrition (7.96, 2.04-31.02) were risk factors of neonatal sepsis. CONCLUSION CoNS, E. coli, and Klebsiella spp were the predominant pathogens in neonatal sepsis in China. AMR was still a significant issue in NICUs. Total parenteral nutrition, multiple antibiotic uses, and PICC placement were the most relevant risk factors.
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Affiliation(s)
- Yuan-Qiang Yu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China
| | - Xiao-Ri He
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China
| | - Li-Jia Wan
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China
| | - Yong-Hui Yang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China
| | - Ping-Yang Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China
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Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive Care Med 2020; 46:1536-1551. [PMID: 32591853 PMCID: PMC7381455 DOI: 10.1007/s00134-020-06106-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospital-acquired (HA) and ICU-acquired (ICU-A) sepsis. METHODS We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. RESULTS Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low- and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies. CONCLUSION HA sepsis is of major public health importance, and the burden is particularly high in ICUs. There is an urgent need to improve the implementation of global and local infection prevention and management strategies to reduce its high burden among hospitalized patients.
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Rao Y, Ren Z, Zhong J, Zhong X, Cao B, Chen D, Pan X, Jia Y, Gao P, Yang B, Zhong Q, Yang J. Risk factors for imipenem-resistant Pseudomonas aeruginosa in neonatal intensive care units in south China. J Hosp Infect 2018; 98:305-308. [DOI: 10.1016/j.jhin.2017.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022]
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Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152335 DOI: 10.1016/b978-0-323-40181-4.00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101136. [PMID: 28953251 PMCID: PMC5664637 DOI: 10.3390/ijerph14101136] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
Abstract
Congenital esophageal atresia with or without tracheoesophageal fistula (CEA ± TEF) is a relatively common malformation that occurs in 1 of 2500–4500 live births. Despite the refinement of surgical techniques, a considerable proportion of children experience short- and long-term respiratory complications, which can significantly affect their health through adulthood. This review focuses on the underlying mechanisms and clinical presentation of respiratory morbidity in children with repaired CEA ± TEF. The reasons for the short-term pulmonary impairments are multifactorial and related to the surgical complications, such as anastomotic leaks, stenosis, and recurrence of fistula. Long-term respiratory morbidity is grouped into four categories according to the body section or function mainly involved: upper respiratory tract, lower respiratory tract, gastrointestinal tract, and aspiration and dysphagia. The reasons for the persistence of respiratory morbidity to adulthood are not univocal. The malformation itself, the acquired damage after the surgical repair, various co-morbidities, and the recurrence of lower respiratory tract infections at an early age can contribute to pulmonary impairment. Nevertheless, other conditions, including smoking habits and, in particular, atopy can play a role in the recurrence of infections. In conclusion, our manuscript shows that most children born with CEA ± TEF survive into adulthood, but many comorbidities, mainly esophageal and respiratory issues, may persist. The pulmonary impairment involves many underlying mechanisms, which begin in the first years of life. Therefore, early detection and management of pulmonary morbidity may be important to prevent impairment in pulmonary function and serious long-term complications. To obtain a successful outcome, it is fundamental to ensure a standardized follow-up that must continue until adulthood.
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Kumar S, Shankar B, Arya S, Deb M, Chellani H. Healthcare associated infections in neonatal intensive care unit and its correlation with environmental surveillance. J Infect Public Health 2017; 11:275-279. [PMID: 28864361 DOI: 10.1016/j.jiph.2017.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/11/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022] Open
Abstract
Healthcare-associated infections (HAI) are frequent complications in neonatal intensive care units (NICU) with varying risk factors and bacteriological profile. There is paucity of literature comparing the bacteriological profile of organisms causing HAI with the environmental surveillance isolates. Therefore, this study aimed to evaluate demographic profile, risk factors and outcome of HAI in NICU and correlate with environmental surveillance. Three hundred newborns with signs and symptoms of sepsis were enrolled in the study group and their profile, risk factors and outcome were compared with the control group. Univariate analysis and multivariable logistic regression were performed. Environmental surveillance results were compared to the bacteriological profile of HAIs. We identified lower gestational age, male gender and apgar score less than 7 at 5min, use of peripheral vascular catheter & ventilator along with their duration as significant risk factors. Mortality rate was 29% in the study group (p<0.05). The HAI site distribution showed blood-stream infections (73%) to be the most common followed by pneumonia (12%) and meningitis (10%). Gram positive cocci were the most common isolates in HAI as well as environmental surveillance. The bacteriological profile of HAI correlates with the environmental surveillance report thus insisting for periodic surveillance and thereby avoiding irrational antibiotic usage.
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Affiliation(s)
- Sanjay Kumar
- Department of Pediatrics, VMMC & Safdarjung Hospital, New Delhi, India.
| | - Binoy Shankar
- Department of Paediatrics, PGIMER & Dr. RML Hospital, New Delhi, India.
| | - Sugandha Arya
- Department of Pediatrics, VMMC & Safdarjung Hospital, New Delhi, India.
| | - Manorma Deb
- Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi, India.
| | - Harish Chellani
- Department of Pediatrics, VMMC & Safdarjung Hospital, New Delhi, India.
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Scala M, Hoy D, Bautista M, Palafoutas JJ, Abubakar K. Pilot study of dornase alfa (Pulmozyme) therapy for acquired ventilator-associated infection in preterm infants. Pediatr Pulmonol 2017; 52:787-791. [PMID: 28052587 DOI: 10.1002/ppul.23656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/26/2016] [Accepted: 11/27/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evaluate the feasibility, safety, and efficacy of adjunctive treatment with dornase alfa in preterm patients with ventilator-associated pulmonary infection (VAPI) compared to standard care. WORKING HYPOTHESIS We hypothesize that therapy with dornase alfa will be safe and well tolerated in the preterm population with no worsening of symptoms, oxygen requirement, or need for respiratory support. STUDY DESIGN Prospective, randomized, blinded, pilot study comparing adjunctive treatment with dornase alfa to sham therapy. In addition to standard care, infants were randomized to receive dornase alfa 2.5 mg nebulized via endotracheal tube (ETT) every 12 hr for 7 days or sham therapy. ETT secretion gram stain and culture and chest X-ray (CXR) findings were evaluated. Respiratory support data were downloaded from the ventilator. RESULTS Fourteen infants developed VAPI between 2012 and 2014; 11 enrolled in the study. Six received dornase alfa and five received sham therapy. Average gestational age at birth was 25 weeks and age at study entry was 31 days. There were no differences in demographics, ETT white blood cell count (WBC), CXR, or mean airway pressure (MAP) between the two groups. There was a trend towards decreased oxygen requirement (FiO2) in the treatment group that did not reach statistical significance. No side effects were observed in the treatment group. CONCLUSION Treatment with dornase alfa is safe and treated infants had some improvement in FiO2 requirement but no improvement in MAP. A larger randomized trial is needed to evaluate the efficacy of this therapy. Pediatr Pulmonol. 2017; 52:787-791. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa Scala
- Division of Neonatology, El Camino Hospital and Lucile Packard Children's Hospital, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto 94304, California
| | - Deborah Hoy
- Division of Neonatology, Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Maria Bautista
- Division of Pulmonology, Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Judith Jones Palafoutas
- Division of Neonatology, Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kabir Abubakar
- Division of Neonatology, Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia
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Sadeghi-Moghaddam P, Arjmandnia M, Shokrollahi M, Aghaali M. Does training improve compliance with hand hygiene and decrease infections in the neonatal intensive care unit? A prospective study. J Neonatal Perinatal Med 2016; 8:221-5. [PMID: 26485556 DOI: 10.3233/npm-15915001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The most important tool in any infection control program is good hand hygiene. Despite recognizing that hand hygiene is crucial in reducing infection rates, hand hygiene compliance remains suboptimal. This study was designed to determine hand hygiene compliance, before and after an educational intervention and its impact on hospital infection rates. METHOD The study was done in neonatal intensive care unit of an educational hospital. All healthcare providers working in the unit at the time of study were trained on importance of hand hygiene and methods of hand hygiene observation; after that hand washing compliance controlled by a physician during postintervention phase. Hand hygiene compliance, healthcare associated infection and mortality rates compared before and after educational intervention. RESULTS Compliance of health-care workers for all hand hygiene opportunities combined was 30% before intervention and improved to 70% in postintervention. In postintervention phase, healthcare associated infection rates and mortality rates decreased significantly as the hand hygiene compliance improved. CONCLUSIONS Good control of hand hygiene compliance by physician after an educational program may have good effect in healthcare associated infections control in neonatal intensive care unit.
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Affiliation(s)
- P Sadeghi-Moghaddam
- Department of Pediatrics-Neonatal, Perinatal Medicine, Qom University of Medical Sciences, Qom, Iran
| | - M Arjmandnia
- Department of Pediatric Diseases, Qom University of Medical Sciences, Qom, Iran
| | - M Shokrollahi
- Department of Pediatric Infectious Diseases, Qom University of Medical Sciences, Qom, Iran
| | - M Aghaali
- Qom University of Medical Sciences, Qom, Iran
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Trivedi A, Maheshwari R, Tarnow-Mordi WO, Saxena N. Lactoferrin for the post-operative management of term neonates after gastrointestinal surgery. Hippokratia 2016. [DOI: 10.1002/14651858.cd012218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Amit Trivedi
- The Children's Hospital at Westmead; Grace Centre for Newborn Care; Westmead NSW Australia 2145
| | - Rajesh Maheshwari
- Westmead Hospital; Department of Neonatology; 807/91B Bridge Road Westmead NSW Australia 2145
| | - William O Tarnow-Mordi
- Westmead Hospital; Department of Neonatal Medicine; Corner of Hawksberry and Darcy Road Westmead NSW Australia 2145
| | - Nivedita Saxena
- Ulster Hospital; Paediatric Department; Upper Newtownards Road Belfast UK BT16 1RH
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Risk factors of late-onset neonatal sepsis in Taiwan: A matched case-control study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:430-5. [DOI: 10.1016/j.jmii.2013.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/11/2013] [Accepted: 08/05/2013] [Indexed: 11/23/2022]
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Cheng HY, Lu CY, Huang LM, Lee PI, Chen JM, Chang LY. Increased frequency of peripheral venipunctures raises the risk of central-line associated bloodstream infection in neonates with peripherally inserted central venous catheters. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:230-6. [DOI: 10.1016/j.jmii.2014.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 12/20/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
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Hei M, Gao X, Gao X, Nong S, Zhang A, Zhang Q, Lee SK. Is family integrated care in neonatal intensive care units feasible and good for preterm infants in China: study protocol for a cluster randomized controlled trial. Trials 2016; 17:22. [PMID: 26758621 PMCID: PMC4711020 DOI: 10.1186/s13063-015-1152-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background By changing the paradigm of neonatal intensive care and integrating parents into the care team, the ‘family integrated care’ (FICare) model developed in Canada ensures that infants receive more consistent care and parents are better able to care for their infants within the neonatal intensive care unit (NICU) and at home. However, Chinese health policy dictates that parents are not allowed into the NICU during their infant’s stay, which inhibits this type of parent–infant interaction and may affect infant outcomes. This project aims to demonstrate that allowing parents to care for their newborn infants in the NICU improves the medical outcomes of infants. Methods/Design This cluster randomized controlled trial will evaluate the feasibility and efficacy of FICare in six Chinese tertiary-level NICUs in China – three ‘intervention’ and three ‘control’ NICUs. The study steps are: (1) planning and preparation; (2) staff recruitment and training; (3) pilot study in two centers; (4) interim analysis and confirmation of sample size for main study; (5) implementation of main study; (6) data analysis and preparation and publication of study reports. The primary outcome measure is duration of hospital stay from admission to discharge. Secondary outcome measures are: (1) clinical outcomes, such as nosocomial infection, (2) weight gain, (3) breastfeeding, (4) time to full feed, and (5) maternal stress. Discussion This study will assess the feasibility and cost-effectiveness of FICare in China. By establishing that FICare is a practical model of NICU care for stable preterm infants in China, this project will have a significant impact on health outcomes, medical practice and policy, and the cost of medical care. The approach used in this project could be transferable to many other areas of medical care, such as pediatrics, chronic care, and geriatrics. Data in this project can be used to inform health policy in NICUs across China so that parents are allowed to enter the NICU and be at their infant’s bedside during the baby’s hospitalization, and modifying the design of NICUs in China to facilitate the participation of parents in caring for their newborns. Trial registration Chinese Clinical Trial Registry ChiCTR-TRC-14004736
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Affiliation(s)
- Mingyan Hei
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Tongzipo Road 138, Changsha, Hunan, 410013, China.
| | - Xiangyu Gao
- Department of Pediatrics, Xuzhou Affiliated Hospital of East South University, Xuzhou, Jiangsu, 220028, China.
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, Hunan, 410008, China.
| | - Shaohan Nong
- Department of Pediatrics, Guangdong General Hospital, Guangzhou, Guangdong, 510080, China.
| | - Aimin Zhang
- Department of Neonatology, Hunan Provincial People's Hospital, Changsha, Hunan, 410007, China.
| | - Qianshen Zhang
- Department of Neonatology, Shenzhen Maternal and Child Healthcare Hospital, Shenzhen, Guangdong, 518028, China.
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1X5, Canada.
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Changing of bloodstream infections in a medical center neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:514-520. [PMID: 26440920 DOI: 10.1016/j.jmii.2015.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/22/2015] [Accepted: 08/31/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. METHODS We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992-2001 and 2002-2007). RESULTS The mortality rate decreased from 16.3% in 1992-2001 to 5.6% in 2008-2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. CONCLUSION Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI.
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Atif ML, Sadaoui F, Bezzaoucha A, Kaddache CA, Boukari R, Djelato S, Boubechou N. Prolongation of Hospital Stay and Additional Costs Due to Nosocomial Bloodstream Infection in an Algerian Neonatal Care Unit. Infect Control Hosp Epidemiol 2015; 29:1066-70. [DOI: 10.1086/591858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Previous studies from developed countries reported that nosocomial bloodstream infection (BSI) in neonatal care units (NCUs) increases length of stay and costs. However, no such information is available for Algerian NCUs.Objective.To evaluate the influence of BSI in neonates on additional charges and length of hospital stay.Design.Prospective, nested case-control study.Setting.The 47-bed NCU of the University Hospital of Blida, Algeria.Patients and Methods.A total of 83 neonates with BSIs (case patients) and 166 neonates without BSIs (control patients), admitted to the NCU during the study period (April 2004 through December 2007), were matched for sex, birth weight, length of NCU stay, and year of hospital admission. Each patient's length of stay in the NCU was obtained prospectively on daily rounds. The estimated cost of each NCU-day was provided by the hospital's finance department. The cost of antibiotics prescribed was provided by the hospital's pharmacy department.Results.The mean additional length of NCU stay for case patients, compared with control patients, was 9.2 days (24.3 vs 15.1 days). The mean additional cost of antibiotics was $546. The mean cumulative additional cost was $1,315.Conclusion.This study highlights the effect of BSI on extra costs for NCU patients, especially costs due to prolongation of hospital stay and increased antibiotic use, and suggests that NCUs in Algeria have a financial interest in reducing the rate of BSI.
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Djordjevic ZM, Markovic-Denic L, Folic MM, Igrutinovic Z, Jankovic SM. Health care-acquired infections in neonatal intensive care units: risk factors and etiology. Am J Infect Control 2015; 43:86-8. [PMID: 25564130 DOI: 10.1016/j.ajic.2014.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/03/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
A 1-year prospective cohort study of health care-acquired infections was conducted at the neonatal intensive care unit of the University Clinical Centre Kragujevac, Serbia. The incidence rate of neonates with health care-acquired infections was 18.6%, and the incidence rate of the infections themselves was 19.4%. The incidence density of the health care-acquired infections was 9.1 per 1,000 patient days. The independent risk factors for health care-acquired infections were birth weight, length of hospitalization, duration of mechanical ventilation, and Apgar score. More than half of all isolated microorganisms were Klebsiella-Enterobacter (39.3%) and Escherichia coli (25.0%).
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Gadallah MAH, Aboul Fotouh AM, Habil IS, Imam SS, Wassef G. Surveillance of health care-associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up. Am J Infect Control 2014; 42:1207-11. [PMID: 25238664 DOI: 10.1016/j.ajic.2014.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reported rates of neonatal health care-associated infections (HAIs) in neonatal intensive care units (NICUs) have risen rapidly in recent years. Little data are available in Egypt, however. The aim of the present study was to determine the incidence of and risk factors for HAIs in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology. METHODS A prospective study was carried out on all neonates admitted in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology in 2012. Centers for Disease Control and Prevention criteria were followed for identifying HAIs. RESULTS A total of 434 neonates were enrolled in the study. The cumulative incidence of HAIs in the NICU was 28%. Bloodstream infections accounted for 85% of HAI episodes; pneumonia, for 10%. The most common organism isolated was Klebsiella spp. The main risk factors identified on multivariable analysis were gestational age <38 weeks (relative risk [RR], 1.63), birth weight <1,500 g (RR, 1.39), mechanical ventilation (RR, 1.74), and surgical procedures (RR, 1.65). The mortality rate attributed to HAIs was 11.75%, and the extra hospital length of stay attributed to HAIs was 8 days. CONCLUSION The high incidence of HAI identified in the study NICU mandates more vigorous infection control interventions.
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Affiliation(s)
| | | | - Ihab Shehad Habil
- Department of Community Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt.
| | - Safaa Shafik Imam
- Department of Pediatrics, Ain Shams Faculty of Medicine, Cairo, Egypt
| | - Ghada Wassef
- Department of Community Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt
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Aelami MH, Lotfi M, Zingg W. Ventilator-associated pneumonia in neonates, infants and children. Antimicrob Resist Infect Control 2014. [DOI: 10.1186/2047-2994-3-30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Romanelli RMDC, Anchieta LM, Carvalho EADA, Glória e Silva LFD, Nunes RVP, Mourão PH, Clemente WT, Bouzada MCF. Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. Braz J Infect Dis 2014; 18:400-5. [PMID: 24690427 PMCID: PMC9427516 DOI: 10.1016/j.bjid.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/23/2013] [Accepted: 12/18/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041). CONCLUSIONS Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.
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Affiliation(s)
- Roberta Maia de Castro Romanelli
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil.
| | - Lêni Márcia Anchieta
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Lorena Ferreira de Glória e Silva
- Pediatrics Infectious Diseases, Hospital Infantil João Paulo II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Paulo Henrique Mourão
- Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Wanessa Trindade Clemente
- Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil; Department of Complementary Propedeutics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Maria Cândida Ferrarez Bouzada
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Kang CH, Tsai CM, Wu TH, Wu HY, Chung MY, Chen CC, Huang YC, Liu SF, Liao DL, Niu CK, Lee CH, Yu HR. Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity. Pediatr Pulmonol 2014; 49:381-8. [PMID: 23359527 DOI: 10.1002/ppul.22750] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/18/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii is increasing. It has a high mortality rate but experience in using inhaled colistin as monotherapy for VAP in children, especially pre-term infants, is limited. This study presents experiences using aerosolized colistin as monotherapy for VAP due to A. baumannii infection in pre-term infants. METHODS Eight pre-term infants (gestational age 25-36 weeks) admitted to the neonatal intensive care unit (NICU) of Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2006 to December 2010 who received inhaled colistin as monotherapy for VAP due to A. baumannii infection were retrospectively evaluated. Of the isolated microorganisms, five were multi-drug resistant strains of A. baumannii (MDR-AB) but all were sensitive to colistin. All patients received inhaled colistin at a dose of 1,000,000 IU (33.4 mg) twice daily for an average of 9.1 days (range, 4-22 days). RESULTS All pre-term infants were cured, with A. baumannii eradicated from airway secretions. There were no clinical or laboratory adverse events related to colistin use. CONCLUSIONS Aerosolized colistin may be used as monotherapy for VAP due to A. baumannii infection in pre-term infants. A larger controlled study is warranted to corroborate the findings.
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Affiliation(s)
- Chia-Hao Kang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Folgori L, Bielicki J, Sharland M. A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections. Arch Dis Child Fetal Neonatal Ed 2013; 98:F518-23. [PMID: 23645589 DOI: 10.1136/archdischild-2012-303149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the reporting of hospital-acquired bloodstream infection (HABSI) and central line-associated BSI (CLABSI) rates in neonatal intensive care units (NICUs). DESIGN Systematic review of evidence published after 2000 reporting HABSI cumulative incidence, crude HABSI and/or CLABSI rate and total patient-days and/or central line-days for single NICU. SETTING Inpatient. PATIENTS Neonates admitted to NICU. MAIN OUTCOME MEASURES To consider the reporting of and relationship between cumulative incidence of BSI and HABSI and/or CLABSI rates. RESULTS 18 studies fulfilled inclusion criteria. There was a wide variability in reporting of HABSI indicators and risk-adjustment strategies with reported crude HABSI and/or CLABSI rates showing an approximately sevenfold variation between centres. Information about NICU size and level of care was not always available. Many studies provided insufficient information about case mix, such as surgical care provision and prematurity. The proportion of total patient-days that were central venous catheters (CVC)-days ranged from 11.7% to 85.4%. Only six studies reported HABSI and CLABSI incidence. Comparing HABSI and CLABSI ranking, we found a relationship between rates. CONCLUSIONS We found significant variability in HABSI rate reporting. Although there appears to be an association between CLABSI and HABSI rates, non-CVC-related BSIs are likely to be highly relevant in some NICUs. If confirmed, and given CLABSI rates are more challenging to collect, it may be more appropriate to use HABSI rates for monitoring NICU healthcare-associated infection (HAI) in some settings. A European network of NICUs using a standardised methodology is required to determine the feasibility and reliability of different risk-adjusted measured of HAI rates.
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Affiliation(s)
- Laura Folgori
- Division of Clinical Sciences, Paediatric Infectious Disease Research Group, St George's University of London, , London, UK
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Mukerji A, Narciso J, Moore C, McGeer A, Kelly E, Shah V. An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes. BMJ Open 2013; 3:bmjopen-2013-003018. [PMID: 23793705 PMCID: PMC3664348 DOI: 10.1136/bmjopen-2013-003018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. DESIGN Preintervention and postintervention observational study. PARTICIPANTS All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012). INTERVENTIONS In the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the '4 moments of HH' and definition of 'baby space' were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU. RESULTS HH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (p<0.01). Infection rates showed an opposing, but concomitant trend in the overall population as well as in infants <1500 g and were 4%, 6% and 4% (p=0.02), and 11%, 21% and 16% (p<0.01), respectively, during the three phases. CONCLUSIONS Interventions to improve HH compliance are challenging to implement and sustain with the need for ongoing reinforcement and education.
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Affiliation(s)
- Amit Mukerji
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Janet Narciso
- Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Moore
- Department of Infection Control, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Edmond Kelly
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vibhuti Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Joseph CJ, Lian WB, Yeo CL. Nosocomial Infections (Late Onset Sepsis) in the Neonatal Intensive Care Unit (NICU). PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: Neonates admitted to the Neonatal Intensive Care Unit (NICU) are at high-risk of developing nosocomial infection. Ongoing infectious disease surveillance is essential to minimise the occurrence of nosocomial infection. To determine the incidence of nosocomial infection, distribution of pathogens, associated risk factors and outcomes, we evaluated a cohort of 263 neonates who were admitted to NICU from May 2005 to May 2007. Methods: The Singapore General Hospital neonatal database was tapped into to obtain information on all nosocomial infections that occurred during the review period. The inpatient case notes of these infants were reviewed, detailed data on epidemiology of infection, results of blood and cerebral spinal fluid culture were collected; associated risk factors and outcomes were evaluated. Results: Out of 255 neonates who were analysed, 20 infants (7.8%) developed nosocomial infection. The vast majority of infections (85%) were caused by Gram-positive organisms with coaugulase-negative Staphylococci accounting for 55% infection. Birth weight and gestational age were inversely related to rate of infection (13% of very low birth weight infants [VLBW] versus 4.1% of non-VLBW infants). Among VLBW infants, prolonged mechanical ventilation, central line insertion and chest tube insertion were associated with an increased rate of late-onset sepsis (LOS). Neonates with LOS had a significantly prolonged hospital stay (mean length of stay 84 days versus 54 days). The mortality rate for nosocomial sepsis was 5%. Conclusion: This study documents the high prevalence of nosocomial infection in neonates admitted to NICU, particularly VLBW infants. Identification of VLBW infants who are at high-risk for LOS and early detection of LOS remain the keys to successful management of this condition.
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Affiliation(s)
| | - Wee Bin Lian
- Department of Neonatal and Developmental Medicine, Singapore General Hospital
| | - Cheo Lian Yeo
- Department of Neonatal and Developmental Medicine, Singapore General Hospital
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Lim WH, Lien R, Huang YC, Chiang MC, Fu RH, Chu SM, Hsu JF, Yang PH. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants. Pediatr Neonatol 2012; 53:228-34. [PMID: 22964280 DOI: 10.1016/j.pedneo.2012.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 11/02/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Neonatal sepsis contributes to great mortality and morbidity among very-low-birth-weight (VLBW) infants. Prevalence and pathogen distribution of sepsis in the neonatal intensive care units (NICUs) vary with time and geographic location. Such information serves as a guide for selection of empirical antibiotics coverage. METHODS This is a case series study performed by retrospective chart review of VLBW infants (birth body weight, BBW, <1500 g) in a medical center during a 5-year period from January 2005 to December 2009. Episodes of positive blood cultures, pathogen distribution and related clinical manifestations were described. RESULTS A total of 158 episodes of sepsis were identified from 1042 VLBW infants. Sepsis rate was 152 per 1000 live births. The vast majority of infections (60.7%) were caused by Gram-positive organisms [G(+)], and overall Coagulase-negative staphylococci (CoNS) (52.5%) were the most common pathogen identified. Prevalence for early-onset sepsis (EOS) was 1% and for late-onset sepsis (LOS) was 14.2%. Infants with EOS had a much higher case fatality rate than LOS (40% vs. 4.7%). Escherichia coli (40%) were the leading pathogen of EOS while CoNS (54.7%) was the leading pathogens of LOS. Overall, apnea and/or bradycardia and/or cyanosis (65.8%), poor activity (48.7%), and increased respiratory effort (43.0%) were the most common presenting features of sepsis. CONCLUSION Unlike term infants, Gram-negative organism and E coli were the leading pathogen of EOS among VLBW infants. Judicious and timely use of antibiotic therapy is crucial in the care of VLBW infants.
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Affiliation(s)
- Wai Ho Lim
- Division of Neonatology, Chang Gung Children's Hospital, School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
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25
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Healthcare-associated infections in a Neonatal Intensive Care Unit in Turkey. Indian Pediatr 2012; 49:951-7. [PMID: 22791673 DOI: 10.1007/s13312-012-0249-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 02/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit. DESIGN Prospective, cohort. SETTING A 38-bed, teaching, referral, neonatal intensive-care unit. PARTICIPANTS All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. METHODS The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. RESULTS The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. CONCLUSIONS Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.
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Hospital-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7151960 DOI: 10.1016/b978-1-4377-2702-9.00096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhao R, Li K, Shen C, Zheng S. The outcome of conservative treatment for anastomotic leakage after surgical repair of esophageal atresia. J Pediatr Surg 2011; 46:2274-8. [PMID: 22152864 DOI: 10.1016/j.jpedsurg.2011.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 09/03/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcome of conservative management of anastomotic leakage (AL) after surgical repair for esophageal atresia. METHODS Data from 85 neonates with esophageal atresia who underwent surgical correction were retrospectively analyzed. Conservative treatment had been adopted for AL. The incidence and severity of postoperative AL as well as its effects were analyzed. RESULTS Among the 85 neonates, postoperative AL occurred in 21 (25%) cases, with major leaks in 15 cases and minor leaks in 6. The stricture index of the 21 neonates with AL (0.615 ± 0.032) was significantly different (P = .008) from that of the 64 neonates without leakage (0.509 ± 0.018). The overall incidence of gastroesophageal reflux (GER) was 36%. Esophageal dysmotility and clinically significant tracheomalacia were observed in 69 and 7 infants, respectively, of the 80 surviving patients. The incidence of GER, dysmotility, and tracheomalacia in patients with or without AL was similar. The severity of GER in patients with different numbers of sessions of dilation was significantly different (P = .0015). CONCLUSIONS Postoperative esophageal AL is effectively treatable by conservative methods in most neonates. The occurrence of AL may aggravate the severity of esophageal stricture but does not affect the incidence of GER, esophageal dysmotility, and tracheomalacia.
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Affiliation(s)
- Rui Zhao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, People's Republic of China
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Yapicioglu H, Ozcan K, Sertdemir Y, Mutlu B, Satar M, Narli N, Tasova Y. Healthcare-associated infections in a neonatal intensive care unit in Turkey in 2008: incidence and risk factors, a prospective study. J Trop Pediatr 2011; 57:157-64. [PMID: 20601690 DOI: 10.1093/tropej/fmq060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this study, we have prospectively recorded healthcare-associated infections (HAIs) in NICU and found incidence density as 18 infections per 1000 patient days. Of the infections, 51.3% was bacteriemia (BSI), and 45.1% was ventilator-associated pneumonia (VAP). Gram-negative microorganisms were predominant in VAP and Staphylococcus epidermidis was the leading microorganism (53.0% of BSIs) in BSIs. Multivariate logistic regression analysis showed the importance of hood O(2) use in days (RR: 1.3) and total parenteral nutrition use in days (RR: 1.09) for BSIs. Umbilical arterial catheterization in days (RR: 1.94), ventilator use in days (RR: 1.05), chest tube (RR: 12.55), orogastric feeding (RR: 3.32) and total parenteral nutrition in days (RR: 1.05) were found to be significantly associated with VAP. In conclusion, incidence density in our unit is high and Gram-negative rods are predominant similar to developing countries. These results strongly suggest improving measures of prevention and control of HAIs in the unit.
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Affiliation(s)
- Hacer Yapicioglu
- Cukurova University Medical Faculty, Department of Pediatrics, Division of Neonatology, Adana, Turkey.
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Ho TS, Wang SM, Wu YH, Shen CF, Lin YJ, Lin CH, Liu CC. Long-term characteristics of healthcare-associated infections in a neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 43:407-15. [PMID: 21075708 DOI: 10.1016/s1684-1182(10)60064-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/26/2009] [Accepted: 08/19/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Healthcare-associated infections in neonatal intensive care units (NICUs) are associated with a significant risk of morbidity and mortality. Knowledge regarding pathogens, primary sources of infection and antibiotic resistance in the NICU is essential for developing management strategies. This study aimed to analyze the long-term characteristics of healthcare-associated infections in a tertiary referral center in southern Taiwan. METHODS Infants < 30 days old, with positive blood, cerebrospinal fluid, urine or tissue fluid cultures during hospitalization in the NICU of National Cheng Kung University Hospital from July 1989 to June 2008 were included in the study. RESULTS In total, 1,417 organisms and episodes were identified during the study period. Gram-positive organisms, Gram-negative organisms and fungi constituted 923 (65.1%), 358 (25.3%) and 136 (9.6%) of the pathogens, respectively. Of the Gram-positive organisms, coagulase-negative staphylococci (51.5%), Staphylococcus aureus (34.8%) and Enterococcus spp. (6.1%) were the major pathogens; and 27% of Staphylococcus aureus isolates were oxacillin-resistant. For the Gram-negative organisms, Klebsiella pneumoniae (22%), Pseudomonas aeruginosa (21.8%), Escherichia coli (16.7%) and Enterobacter cloacae (16.7%) were dominant. Also, Candida albicans accounted for 50% of fungal infections. The most common source of infection was bloodstream infection (59.0%), and 5.6% of these were catheter-related. Skin and soft tissue infections were also frequent (26.3%). CONCLUSION Bloodstream and skin/soft tissue infections caused by commensal species play an important role in healthcare-associated infections in the NICU. New measures should be developed in response to the changing patterns in the NICU.
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Affiliation(s)
- Tzong-Shiann Ho
- Department of Pediatrics, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
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Gmyrek D, Koch R, Vogtmann C, Kaiser A, Friedrich A. [Risk-adjusted assessment: late-onset infection in neonates]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:124-32. [PMID: 21496781 DOI: 10.1016/j.zefq.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis. METHOD The perinatal/neonatal database of 41,055 newborns of the Saxonian quality surveillance from 1998 to 2004 was analysed. Based on 18 possible risk factors, a logistic regression model was used to develop a specific risk predictor for the quality indicator "late-onset infection". RESULTS The developed risk predictor for the incidence of late-onset infection could be described by 4 of the 18 analysed risk factors, namely gestational age, admission from home, hypoxic ischemic encephalopathy and B-streptococcal infection. The AUC(ROC) value of this quality indicator was 83.3%, which demonstrates its reliability. The hospital ranking based on the adjusted risk assessment was very different from hospital rankings before this adjustment. The average correction of ranking position was 4.96 for 35 clinics. CONCLUSION The application of the risk adjustment method proposed here allows for a more objective comparison of the incidence of the quality indicator "late onset infection" among different hospitals.
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Affiliation(s)
- Dieter Gmyrek
- Arbeitsgruppe Qualitätssicherung Perinatologie/Neonatologie der Sächsischen Landesärztekammer.
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Clarke D, Gowrishankar M, Etches P, Lee BE, Robinson JL. Management and outcome of positive urine cultures in a neonatal intensive care unit. J Infect Public Health 2010; 3:152-8. [PMID: 21126719 DOI: 10.1016/j.jiph.2010.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/13/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the management and outcome of positive urine cultures in a neonatal intensive care unit (NICU). STUDY DESIGN A chart review was completed of infants born October 1, 2004 to December 31, 2006 and admitted to the NICU at the Royal Alexandra Hospital, Edmonton, Alberta with any growth of bacteria or fungi in urine. RESULTS Positive urine cultures were obtained in 64 of 2936 admissions (2%) and were classified as contaminated urines (n=34), possible urinary tract infection (UTI) (n=14), definite UTI (n=10), and candidal UTI (n=6). Management was inconsistent. Two children required new assisted ventilation but no other complications occurred. CONCLUSIONS The diagnosis of UTI in NICU is hampered by use of urine collection methods that are subject to contamination. Outcome is generally excellent, but there is a great need for guidelines on management of positive urine cultures in the NICU.
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Affiliation(s)
- Denise Clarke
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
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Liu CY, Liao CH, Chen YC, Chang SC. Changing Epidemiology of Nosocomial Bloodstream Infections in 11 Teaching Hospitals in Taiwan Between 1993 and 2006. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:416-29. [PMID: 21075709 DOI: 10.1016/s1684-1182(10)60065-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/30/2009] [Accepted: 08/25/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Chia-Ying Liu
- Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei, Taiwan
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Abstract
Ventilator-associated pneumonia (VAP) is one of the leading causes of preventable morbidity and mortality in neonatal intensive care units. This review examines the epidemiology and pathogenesis of VAP in neonates as well as the dilemmas faced by caregivers to diagnose and prevent VAP.
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Affiliation(s)
- Jeffery S Garland
- Wheaton Franciscan Healthcare, St Joseph Hospital, Glendale, 5000 West Chamber, Milwaukee, WI 53210, USA.
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Abstract
Late-onset sepsis in premature infants is a major cause of morbidity, mortality, and increased medical costs. Risk factors include low birth weight, low gestational age, previous antimicrobial exposure, poor hand hygiene, and central venous catheters. Methods studied to prevent late-onset sepsis include early feedings, immune globulin administration, prophylactic antimicrobial administration, and improved hand hygiene. In this review, we will outline the risk factors for development of late-onset sepsis and evidence supporting methods for prevention of late-onset sepsis in premature infants.
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Affiliation(s)
- L Corbin Downey
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA
| | - P Brian Smith
- Duke University Department of Pediatrics and Duke Clinical Research Institute, Durham, NC
| | - Daniel K Benjamin
- Duke University Department of Pediatrics and Duke Clinical Research Institute, Durham, NC
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Xu XF, Ma XL, Chen Z, Shi LP, Du LZ. Clinical characteristics of nosocomial infections in neonatal intensive care unit in eastern China. J Perinat Med 2010; 38:431-7. [PMID: 20297900 DOI: 10.1515/jpm.2010.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective cohort study on nosocomial infections (NI) in the neonatal intensive care unit (NICU) was performed in the Children's Hospital of Zhejiang University, Hangzhou district, China. The most common infection site was pneumonia and bloodstream infection. Low admission age, long NICU stay, and mechanical ventilation were significant risk factors for NI. Klebsiella pneumoniae was the most common pathogen, followed by Acinetobacter baumannii, Staphylococcus epidermidi, Pseudomonas aeruginosa, Enterobacter cloacae, and Stenotrophomonas maltophilia. Antibiotic resistance of the isolated bacterium was high. In conclusion, this study described the clinical characteristics of NI in a Chinese NICU, which might contribute to implementation of more effective therapeutic and preventive strategies.
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Affiliation(s)
- Xue-Feng Xu
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang province, P.R. China
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Wu JH, Chen CY, Tsao PN, Hsieh WS, Chou HC. Neonatal sepsis: a 6-year analysis in a neonatal care unit in Taiwan. Pediatr Neonatol 2009; 50:88-95. [PMID: 19579754 DOI: 10.1016/s1875-9572(09)60042-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neonatal sepsis is the most serious problem in neonatal intensive care, resulting in significant morbidity and mortality. We evaluated the causative pathogen, drug sensitivity, hematological parameters, clinical course and mortality rate of neonatal sepsis in a Taiwanese medical center and compared our results to those of previous studies conducted in Taiwan. METHODS Neonates admitted to the neonatal intensive care unit (NICU) at National Taiwan University Hospital (NTUH) between January 2001 and December 2006 were included in this study. Patients were divided into early-onset sepsis and late-onset sepsis groups if their culture tested positive within the first 7 days of life or later, respectively. RESULTS A total of 109 episodes of sepsis were identified in 100 neonates. The incidence of sepsis was 4.06% among all NICU admissions. Most neonates with early-onset sepsis were term infants, while very low birth weight (VLBW) and preterm infants accounted for the majority of cases of late-onset sepsis. In early-onset sepsis, the most common pathogens responsible included group B streptococci (GBS) (36%) and Escherichia coli (E. coli) (26%). GBS was associated with more meningitis involvement but lower incidence of mortality compared with E. coli. The most common causative microorganisms in late-onset sepsis were coagulase-negative staphylococci (CONS) (40%) and Candida (15%). The sepsis-related mortality rates were higher in early-onset sepsis (10%) than in late-onset sepsis (7%). CONCLUSION Unlike previous reports from Taiwan, in the present study, GBS was found to be the leading pathogen in early-onset sepsis. GBS screening and intrapartum antibiotic prophylaxis guidelines should be used in Taiwan to prevent early neonatal sepsis. The most common causative microorganisms of late-onset sepsis were CONS and Candida species. Candida parapsilosis was associated with a high mortality rate.
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Affiliation(s)
- Jun-Ho Wu
- Department of Pediatrics, Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
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Orsi GB, d'Ettorre G, Panero A, Chiarini F, Vullo V, Venditti M. Hospital-acquired infection surveillance in a neonatal intensive care unit. Am J Infect Control 2009; 37:201-3. [PMID: 19059676 DOI: 10.1016/j.ajic.2008.05.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 05/06/2008] [Accepted: 05/07/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) represent an important cause of morbidity and mortality in neonatal intensive care units (NICUs). METHODS All neonates admitted for > 48 hours between January 2003 and December 2006 in the NICU of the teaching hospital Umberto I of Rome, Italy were considered. RESULTS Of the 575 neonates evaluated, 76 (13.2%) developed a total of 100 HAIs, including 36 bloodstream infections (BSIs), 33 pneumonias, 19 urinary tract infections, 8 conjunctivitis, and 4 onphalitis. There were 7.8 HAIs/1000 patient-days and 12.5 BSIs/1000 days of umbilical catheterization. Logistic analysis identified an association with mechanical ventilation (odds ratio [OR] = 3.05; 95% confidence interval [CI] = 1.75 to 5.31; P < .01) and birth weight <or= 1500 g (OR = 2.34; 95% CI = 1.36 to 4.03; P < .01). Thirty-five neonates (6.1%) died. Klebsiella pneumoniae (37.7%) and coagulase-negative staphylococci (28.6%) were the most frequently isolated microorganisms. Only 3 Candida spp determined BSIs (8.3%). BSI mortality was higher in infections with gram-negative pathogens (36.4%) than in infections with gram-positive pathogens (4.5%). CONCLUSIONS Although we found a low infection and mortality rate, attention should be directed toward antibiotic-resistant gram-negative pathogens.
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Garland JS, Uhing MR. Strategies to prevent bacterial and fungal infection in the neonatal intensive care unit. Clin Perinatol 2009; 36:1-13. [PMID: 19161861 DOI: 10.1016/j.clp.2008.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hospital-acquired infections are one of the leading causes of preventable morbidity and mortality in neonatal intensive care units (NICUs). Device-related infections, such as catheter-associated blood stream infections (CABSIs) and ventilator-associated pneumonia (VAP), are the most common nosocomial infections. This review examines the pathogenesis of CABSIs and methods, widely accepted and novel, that can be used to help prevent them. Strategies to prevent fungal infections, which are often associated with the presence of a central venous catheter, are also reviewed. Finally, the dilemmas in the diagnosis and prevention of VAP in the NICU are discussed.
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Affiliation(s)
- Jeffery S Garland
- Wheaton Franciscan Health Care, St. Joseph Hospital, 3070 North 51st Street, Suite 309 Milwaukee, WI 53210, USA.
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Al Jarousha AMK, El Jadba AHN, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 2009; 13:623-8. [PMID: 19144555 DOI: 10.1016/j.ijid.2008.08.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 06/30/2008] [Accepted: 08/29/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We performed a prospective case-control study of bloodstream infections in order to determine the infection rate of Acinetobacter baumannii and to determine the risk factors associated with infection and mortality. METHODS Between February 2004 and January 2005, 579 consecutive blood specimens were collected from the two neonatal intensive care units (NICUs) of Al-Nasser and Al-Shifa hospitals in Gaza City. RESULTS Forty (6.9%) isolates of A. baumannii were obtained from neonates aged under 28 days. Of the patients, 62.5% were male and 37.5% were female. Compared to matched, uninfected controls, statistically significant risk factors were weight<1500 g (odds ratio (OR) 3.89, p<0.001), age <7 days (OR 2.33, p=0.027), median hospitalization of =20 days (OR 3.1, p=0.003), mechanical ventilation (OR 3.5, p=0.001), use of a central venous catheter (CVC; OR 10.5, p<0.001), and prior antibiotic use (OR 4.85, p=0.003). The overall mortality was also significantly different (overall mortality 37.5% in cases vs. 12% in uninfected controls; OR 4.4, p=0.001). Compared to infected controls, statistically significant risk factors were mechanical ventilation (OR 2.68, p=0.008), use of a CVC (OR 6.68, p<0.001), and prior antibiotic use (OR 5.68, p=0.001). The multidrug-resistant type was significantly associated with death in the neonates (p=0.023). The isolates of A. baumannii were resistant to commonly used antibiotics, while susceptible to meropenem (92.5%), imipenem (90%), ciprofloxacin (75%), gentamicin (57.5%), and ceftriaxone (50%). CONCLUSIONS The infection rate with multidrug-resistant A. baumannii is considerable and alarming in NICU infants, and is associated with significant mortality.
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Affiliation(s)
- Abdel Moati Kh Al Jarousha
- Laboratory Medicine Department, Al Azhar University, and Medical Microbiology Department, Al Dorra Pediatric Hospital, Gaza, Palestine.
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Kugelman A, Inbar-Sanado E, Shinwell ES, Makhoul IR, Leshem M, Zangen S, Wattenberg O, Kaplan T, Riskin A, Bader D. Iatrogenesis in neonatal intensive care units: observational and interventional, prospective, multicenter study. Pediatrics 2008; 122:550-5. [PMID: 18762525 DOI: 10.1542/peds.2007-2729] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to determine the incidence of iatrogenic events in NICUs and to determine whether awareness of iatrogenic events could influence their occurrence. METHODS We performed a prospective, observational, interventional, multicenter study including all consecutive infants hospitalized in 4 NICUs. In the first 3 months (observation period), the medical teams were unaware of the study; in the next 3 months (intervention period), they were made aware of daily ongoing monitoring of iatrogenic events by a designated "Iatrogenesis Advocate." RESULTS The numbers of infants admitted to the NICUs were comparable during the observation and intervention periods (328 and 369 infants, respectively). There was no difference between the 2 periods with respect to the number of infants of <1500 g, hospitalization days, or mean daily occupancy of the NICUs. Although the prevalence rates of iatrogenic events were comparable in the observation and intervention periods (18.0 and 18.2 infants with iatrogenic events per 100 hospitalized infants, respectively), the incidence rate decreased significantly during the intervention period (3.2 and 2.4 iatrogenic events per 100 hospitalization days of new admissions, respectively). Of all iatrogenic events, 7.9% were classified as life-threatening and 45.1% as harmful. There was no death related to an iatrogenic event. Eighty-three percent of iatrogenic events were considered preventable, of which 26.9% resulted from medical errors in ordering or delivery of medical care. Only 1.6% of all iatrogenic events were intercepted before reaching the infants, and only 47.0% of iatrogenic events were corrected. For younger and smaller infants, the rate of iatrogenic events was higher (57% at gestational ages of 24 to 27 weeks, compared with 3% at term) and the iatrogenic events were more severe and harmful. Increased length of stay was associated independently with more iatrogenic events. CONCLUSIONS Neonatal medical teams and parents should be aware of the burden of iatrogenesis, which occurs at a significant rate.
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Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb St, Haifa, 31048, Israel.
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Recent trends and prevention of infection in the neonatal intensive care unit. Curr Opin Infect Dis 2008; 21:350-6. [DOI: 10.1097/qco.0b013e3283013af4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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