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Faust K, Freitag N, Barrientos G, Hartel C, Blois SM. Galectin-Levels Are Elevated in Infants Born Preterm Due to Amniotic Infection and Rapidly Decline in the Neonatal Period. Front Immunol 2021; 11:599104. [PMID: 33717050 PMCID: PMC7949913 DOI: 10.3389/fimmu.2020.599104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Galectin (gal)-1, -3, and -9 are members of a family of glycan binding proteins that mediate complex interactions between decidual, inflammatory and trophoblast cells modulating several processes during gestation, control of the maternal immune system, and parturition. Their immunomodulatory role in preterm birth and postnatal expression in preterm infants is unknown. We performed a single center prospective study of 170 preterm infants with a gestational age below 35 weeks. Peripheral venous blood samples were collected during the neonatal period and galectin-1, -3, and -9 were determined by ELISA. We noted a strong decline of circulating gal-1 and -3 levels but not gal-9 from birth to day 7 of life. There was an inverse correlation of gal-1 and -3 levels at birth with gestational age. Gal-1 levels were remarkably increased in infants born to amniotic infection syndrome (AIS), which was also observed for gal-9 levels. Infants who developed early-onset sepsis had higher levels of gal-3 at day 1 as compared to unaffected infants. Our observational data imply that galectin-1, -3, and -9 levels are elevated in preterm infants born in an inflammatory milieu such as AIS or EOS. Future studies need to address whether galectins mediate inflammation-induced preterm birth and could therefore be a target for clinical trials.
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Affiliation(s)
- Kirstin Faust
- Department of Pediatrics, University of Luebeck, University Hospital of Schleswig-Holstein, Lübeck, Germany.,German Center for Infection Research, Lübeck, Germany
| | - Nancy Freitag
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Division of General Internal and Psychosomatic Medicine, Berlin, Germany
| | - Gabriela Barrientos
- Laboratorio de Medicina Experimental, Hospital Alemán-Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Christoph Hartel
- German Center for Infection Research, Lübeck, Germany.,Department of Paediatrics, University of Würzburg, Würzburg, Germany
| | - Sandra M Blois
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Al-Matary A, Huseynova R, Qaraqe M, Aldandan F. The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Pagel J, Twisselmann N, Rausch TK, Waschina S, Hartz A, Steinbeis M, Olbertz J, Nagel K, Steinmetz A, Faust K, Demmert M, Göpel W, Herting E, Rupp J, Härtel C. Increased Regulatory T Cells Precede the Development of Bronchopulmonary Dysplasia in Preterm Infants. Front Immunol 2020; 11:565257. [PMID: 33101284 PMCID: PMC7554370 DOI: 10.3389/fimmu.2020.565257] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022] Open
Abstract
Regulatory T cells (Tregs) are important for the ontogenetic control of immune activation and tissue damage in preterm infants. However, the role of Tregs for the development of bronchopulmonary dysplasia (BPD) is yet unclear. The aim of our study was to characterize CD4+ CD25+ forkhead box protein 3 (FoxP3)+ Tregs in peripheral blood of well-phenotyped preterm infants (n = 382; 23 + 0 – 36 + 6 weeks of gestational age) with a focus on the first 28 days of life and the clinical endpoint BPD (supplemental oxygen for longer than 28 days of age). In a subgroup of preterm infants, we characterized the immunological phenotype of Tregs (n = 23). The suppressive function of Tregs on CD4+CD25- T cells was compared in preterm, term and adult blood. We observed that extreme prematurity was associated with increased Treg frequencies which peaked in the second week of life. Independent of gestational age, increased Treg frequencies were noted to precede the development of BPD. The phenotype of preterm infant Tregs largely differed from adult Tregs and displayed an overall naïve Treg population (CD45RA+/HLA-DR-/Helios+), especially in the first days of life. On day 7 of life, a more activated Treg phenotype pattern (CCR6+, HLA-DR+, and Ki-67+) was observed. Tregs of preterm neonates had a higher immunosuppressive capacity against CD4+CD25- T cells compared to the Treg compartment of term neonates and adults. In conclusion, our data suggest increased frequencies and functions of Tregs in preterm neonates which display a distinct phenotype with dynamic changes in the first weeks of life. Hence, the continued abundance of Tregs may contribute to sustained inflammation preceding the development of BPD. Functional analyses are needed in order to elucidate whether Tregs have potential as future target for diagnostics and therapeutics.
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Affiliation(s)
- Julia Pagel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany.,Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tanja K Rausch
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,Department of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Silvio Waschina
- Research Group Medical Systems Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Annika Hartz
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | | | - Kathrin Nagel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Alena Steinmetz
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Kirstin Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Martin Demmert
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany.,University Children's Hospital, University of Würzburg, Würzburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Lübeck, Germany
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4
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Healthcare-associated bloodstream infection trends under a provincial surveillance program. Infect Control Hosp Epidemiol 2020; 40:307-313. [PMID: 30887941 DOI: 10.1017/ice.2018.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE BACTOT, Quebec's healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework. DESIGN A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non-catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2-10 of surveillance relative to year 1. RESULTS Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12-5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2-10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%-89%) higher than the first year rate. CONCLUSIONS HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.
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Surveillance von nosokomialen Infektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:228-241. [DOI: 10.1007/s00103-019-03077-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Estañ-Capell J, Alarcón-Torres B, Bermúdez JD, Martínez-Rodríguez L, Martínez-Costa C. Effect of a surveillance system for decreasing neonatal nosocomial infections. Early Hum Dev 2019; 131:36-40. [PMID: 30825743 DOI: 10.1016/j.earlhumdev.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nosocomial infection in very low birthweight (VLBW) infants is a common complication with high morbimortality. New strategies to reduce its occurrence have recently led to the development of neonatal surveillance programs. AIMS To determine whether the NeoKissEs surveillance system implementation in our neonatal unit has been associated with a decrease in nosocomial infection in VLBW infants, as well as a reduction in the use of antibiotics and central venous catheters (CVC). STUDY DESIGN AND SUBJECTS Retrospective and descriptive study of infants <1500 g admitted between January 2011 and December 2017. Rates of use of antibiotics and CVC were calculated, as well as late-onset sepsis incidence. Data were compared before and after the surveillance system implementation. RESULTS 299 patients were recruited. We excluded seven patients, who died <72 h. Of the remainder (n = 292), 149 were in the pre-intervention period and 143 in the post-intervention period. We found a significant decrease in the incidence density of sepsis comparing these two periods (5.98 vs. 4.08) (p = 0.03). Although no differences in antibiotic and CVC rates of use between both groups were found, a significant decrease in antibiotic use was observed comparing the first and last year of the intervention (38% vs. 24%) (p = 0.03). A higher percentage of breastfed infants was observed (39% vs. 59%) (p = 0.001) in the post-intervention group. CONCLUSIONS Surveillance systems are useful to reduce nosocomial infection in VLBW infants. Reduction in antibiotic and CVC use requires longer intervention time. Promotion of breastfeeding seems to be a very effective associated strategy.
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Affiliation(s)
- Javier Estañ-Capell
- Neonatal Unit, Hospital Clínico Universitario, Valencia, Spain; Department of Pediatrics, School of Medicine, University of Valencia, Spain.
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8
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[Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]. An Pediatr (Barc) 2018; 91:3-12. [PMID: 30262156 DOI: 10.1016/j.anpedi.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. METHODS We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. RESULTS Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. CONCLUSIONS The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.
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Rosado V, Camargos PA, Anchieta LM, Bouzada MC, de Oliveira GM, Clemente WT, Romanelli RMDC. Risk factors for central venous catheter‐related infections in a neonatal population – systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rosado V, Camargos PAM, Anchieta LM, Bouzada MCF, Oliveira GMD, Clemente WT, Romanelli RMDC. Risk factors for central venous catheter-related infections in a neonatal population - systematic review. J Pediatr (Rio J) 2018; 94:3-14. [PMID: 28866323 DOI: 10.1016/j.jped.2017.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/10/2017] [Accepted: 01/21/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. DATA SOURCE The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. DATA SYNTHESIS A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. CONCLUSION Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections.
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Affiliation(s)
- Viviane Rosado
- Universidade Federal de Minas Gerais (UFMG), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Comissão de Controle e Infecção Hospitalar, Belo Horizonte, MG, Brazil.
| | - Paulo A M Camargos
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Lêni M Anchieta
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Cuidados Neonatais Progressivos, Belo Horizonte, MG, Brazil
| | - Maria C F Bouzada
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Cuidados Neonatais Progressivos, Belo Horizonte, MG, Brazil
| | - Gabriela M de Oliveira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Wanessa T Clemente
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Comissão de Controle e Infecção Hospitalar, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Avaliação Complementar, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Equipe de Doenças Infecciosas do Transplante de Órgãos, Belo Horizonte, MG, Brazil
| | - Roberta M de C Romanelli
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Comissão de Controle e Infecção Hospitalar, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
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11
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Straub J, Paula H, Mayr M, Kasper D, Assadian O, Berger A, Rittenschober-Böhm J. Diagnostic accuracy of the ROCHE Septifast PCR system for the rapid detection of blood pathogens in neonatal sepsis-A prospective clinical trial. PLoS One 2017; 12:e0187688. [PMID: 29117261 PMCID: PMC5678863 DOI: 10.1371/journal.pone.0187688] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/24/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction Diagnosis of neonatal sepsis remains a major challenge in neonatology. Most molecular-based methods are not customized for neonatal requirements. The aim of the present study was to assess the diagnostic accuracy of a modified multiplex PCR protocol for the detection of neonatal sepsis using small blood volumes. Methods 212 episodes of suspected neonatal late onset sepsis were analyzed prospectively using the Roche SeptiFast® MGRADE PCR with a modified DNA extraction protocol and software-handling tool. Results were compared to blood culture, laboratory biomarkers and clinical signs of sepsis. Results Of 212 episodes, 85 (40.1%) were categorized as “not infected”. Among these episodes, 1 was false positive by blood culture (1.2%) and 23 were false positive by PCR (27.1%). Of 51 (24.1%) episodes diagnosed as “culture proven sepsis”, the same pathogen was detected by blood culture and PCR in 39 episodes (76.5%). In 8 episodes, more pathogens were detected by PCR compared to blood culture, and in 4 episodes the pathogen detected by blood culture was not found by PCR. One of these episodes was caused by Bacillus cereus, a pathogen not included in the PCR panel. In 76/212 (35.8%) episodes, clinical sepsis was diagnosed. Among these, PCR yielded positive results in 39.5% of episodes (30/76 episodes). For culture-positive sepsis, PCR showed a sensitivity of 90.2% (95%CI 86.2–94.2%) and a specificity of 72.9% (95%CI 67.0–79.0%). Conclusion The Roche SeptiFast® MGRADE PCR using a modified DNA extraction protocol showed acceptable results for rapid detection of neonatal sepsis in addition to conventional blood culture. The benefit of rapid pathogen detection has to be balanced against the considerable risk of contamination, loss of information on antibiotic sensitivity pattern and increased costs.
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Affiliation(s)
- Julia Straub
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Vienna, Austria
| | - Helga Paula
- Department of Hospital Epidemiology and Infection Control, Medical University Vienna, Vienna, Austria
| | - Michaela Mayr
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Vienna, Austria
| | - David Kasper
- Department of Pediatrics and Adolescent Medicine, Research Core Unit of Pediatric Biochemistry and Analytics, Medical University Vienna, Vienna, Austria
| | - Ojan Assadian
- Department of Hospital Epidemiology and Infection Control, Medical University Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Vienna, Austria
| | - Judith Rittenschober-Böhm
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Vienna, Austria
- * E-mail:
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12
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Schwarz J, Scheckenbach V, Kugel H, Spring B, Pagel J, Härtel C, Pauluschke-Fröhlich J, Peter A, Poets CF, Gille C, Köstlin N. Granulocytic myeloid-derived suppressor cells (GR-MDSC) accumulate in cord blood of preterm infants and remain elevated during the neonatal period. Clin Exp Immunol 2017; 191:328-337. [PMID: 28963753 DOI: 10.1111/cei.13059] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 12/17/2022] Open
Abstract
Preterm delivery is the leading cause of perinatal morbidity and mortality. Among the most important complications in preterm infants are peri- or postnatal infections. Myeloid-derived suppressor cells (MDSC) are myeloid cells with suppressive activity on other immune cells. Emerging evidence suggests that granulocytic MDSC (GR-MDSC) play a pivotal role in mediating maternal-fetal tolerance. The role of MDSC for postnatal immune-regulation in neonates is incompletely understood. Until the present time, nothing was known about expression of MDSC in preterm infants. In the present pilot study, we quantified GR-MDSC counts in cord blood and peripheral blood of preterm infants born between 23 + 0 and 36 + 6 weeks of gestation (WOG) during the first 3 months of life and analysed the effect of perinatal infections. We show that GR-MDSC are increased in cord blood independent of gestational age and remain elevated in peripheral blood of preterm infants during the neonatal period. After day 28 they drop to nearly adult levels. In case of perinatal or postnatal infection, GR-MDSC accumulate further and correlate with inflammatory markers C-reactive protein (CRP) and white blood cell counts (WBC). Our results point towards a role of GR-MDSC for immune-regulation in preterm infants and render them as a potential target for cell-based therapy of infections in these patients.
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Affiliation(s)
- J Schwarz
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - V Scheckenbach
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - H Kugel
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - B Spring
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - J Pagel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - C Härtel
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Germany
| | | | - A Peter
- German Centre for Diabetes Research (DZD), Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tuebingen, Tuebingen, Germany.,Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, Tuebingen University Hospital, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - C Gille
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - N Köstlin
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
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13
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Pereira-da-Silva L, Nóbrega S, Rosa ML, Alves M, Pita A, Virella D, Papoila AL, Serelha M, Cordeiro-Ferreira G, Koletzko B. Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions. Clin Nutr ESPEN 2017; 22:7-12. [PMID: 29415837 DOI: 10.1016/j.clnesp.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/07/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. METHODS A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. RESULTS Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53-55.77) than in SMOF (9.1%, 95% CI 2.53-27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). CONCLUSION Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. TRIAL REGISTRATION ClinicalTrials.gov, NCT02633384.
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Affiliation(s)
- Luís Pereira-da-Silva
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
| | - Sara Nóbrega
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Luísa Rosa
- Pharmacy Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Pita
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Daniel Virella
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Micaela Serelha
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gonçalo Cordeiro-Ferreira
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität München, Division Metabolic Diseases and Nutrition, Department of Pediatrics, Dr. von Hauner Children's Hospital, Univ. of Munich Medical Center, Munich, Germany
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14
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Impact of nosocomial infections surveillance on nosocomial infection rates: A systematic review. Int J Surg 2017; 42:164-169. [PMID: 28476543 DOI: 10.1016/j.ijsu.2017.04.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to previously studies, nosocomial infections (NIs) surveillance could effectively reduce infection rates. As NIs surveillance systems have been implemented in some hospitals for several years, their impact on NIs need to be explored. Therefore, the purpose of this review is to evaluate the tendency of NI rates during the surveillance period and the impact of surveillance on NI rates. METHODS A systematic literature search of the PubMed database to identify papers that evaluated effect of surveillance on NIs, all kinds of NIs occurred during hospitalization or discharged were included. Exclude articles investigated the surveillance combined with other infection control measures. RESULTS Twenty-five articles were included. NI rates had different levels of reduction during surveillance period, the reduction were not limited by state, department, surveillance system, and NI type. Continuous surveillance had a positive impact on NI, OR/RR were ranged from 0.43 to 0.95. CONCLUSION Participation in NI surveillance is associated with reducing infection rates, though RCTs need to further prove the effective role of surveillance. Hospitals may consider to perform NIs surveillance systems according to its own conditions.
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15
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Różańska A, Wójkowska-Mach J, Adamski P, Borszewska-Kornacka M, Gulczyńska E, Nowiczewski M, Helwich E, Kordek A, Pawlik D, Bulanda M. Antibiotic consumption in laboratory confirmed vs. non-confirmed bloodstream infections among very low birth weight neonates in Poland. Ann Clin Microbiol Antimicrob 2017; 16:20. [PMID: 28359268 PMCID: PMC5374675 DOI: 10.1186/s12941-017-0196-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 03/23/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Newborns are a population in which antibiotic consumption is extremely high. Targeted antibiotic therapy should help to reduce antibiotics consumption. The aim of this study was an assessment of antibiotic usage in bloodstream infections treatment in the Polish Neonatology Surveillance Network (PNSN) and determining the possibility of applying this kind of data in infection control, especially for the evaluation of standard methods of microbiological diagnostics. METHODS Data were collected between 01.01.2009 and 31.12.2013 in five teaching NICUs from the PNSN. The duration of treatment in days (DOT) and the defined daily doses (DDD) were used for the assessment of antibiotics consumption. RESULTS The median DOT for a single case of BSI amounted to 8.0 days; whereas the median consumption expressed in DDD was 0.130. In the case of laboratory confirmed BSI, median DOT was 8 days, and consumption-0.120 DDD. Median length of therapy was shorter for unconfirmed cases: 7 days, while the consumption of antibiotics was higher-0.140 DDD (p < 0.0001). High consumption of glycopeptides expressed in DOTs was observed in studied population, taking into account etiology of infection. CONCLUSIONS Even application of classical methods of microbiological diagnostics significantly reduces the consumption of antibiotics expressed by DDD. However, the high consumption of glycopeptides indicates the necessity of applying rapid diagnostic assays. Nevertheless, the assessment of antibiotic consumption in neonatal units represents a methodological challenge and requires the use of different measurement tools.
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Affiliation(s)
- A. Różańska
- Chair of Microbiology, Jagiellonian University Medical College, 18 Czysta Street, 31-121 Krakow, Poland
| | - J. Wójkowska-Mach
- Chair of Microbiology, Jagiellonian University Medical College, 18 Czysta Street, 31-121 Krakow, Poland
| | - P. Adamski
- Institute of Nature Conservation Polish Academy of Sciences, Krakow, Poland
| | - M. Borszewska-Kornacka
- Clinic of Neonatology and Intensive Neonatal Care, Warsaw Medical University, Warsaw, Poland
| | - E. Gulczyńska
- Clinic of Neonatology, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
| | - M. Nowiczewski
- Clinic of Neonatology, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
| | - E. Helwich
- Clinic of Neonatology and Intensive Neonatal Care, Institute of Mother and Child, Warsaw, Poland
| | - A. Kordek
- Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - D. Pawlik
- Clinic of Neonatology, Jagiellonian University Medical College, Krakow, Poland
| | - M. Bulanda
- Chair of Microbiology, Jagiellonian University Medical College, 18 Czysta Street, 31-121 Krakow, Poland
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16
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Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6:6. [PMID: 28078082 PMCID: PMC5223492 DOI: 10.1186/s13756-016-0149-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.
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Affiliation(s)
- Julie Storr
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Walter Zingg
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Nizam Damani
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jacqui Reilly
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M Lindsay Grayson
- Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
| | - Edward Kelley
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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17
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Tröger B, Härtel C, Buer J, Dördelmann M, Felderhoff-Müser U, Höhn T, Hepping N, Hillebrand G, Kribs A, Marissen J, Olbertz D, Rath PM, Schmidtke S, Siegel J, Herting E, Göpel W, Steinmann J, Stein A. Clinical Relevance of Pathogens Detected by Multiplex PCR in Blood of Very-Low-Birth Weight Infants with Suspected Sepsis - Multicentre Study of the German Neonatal Network. PLoS One 2016; 11:e0159821. [PMID: 27472282 PMCID: PMC4966931 DOI: 10.1371/journal.pone.0159821] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/09/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction In the German Neonatal Network (GNN) 10% of very-low-birth weight infants (VLBWI) suffer from blood-culture confirmed sepsis, while 30% of VLBWI develop clinical sepsis. Diagnosis of sepsis is a difficult task leading to potential over-treatment with antibiotics. This study aims to investigate whether the results of blood multiplex-PCR (SeptiFast®) for common sepsis pathogens are relevant for clinical decision making when sepsis is suspected in VLBWI. Methods We performed a prospective, multi-centre study within the GNN including 133 VLBWI with 214 episodes of suspected late onset sepsis (LOS). In patients with suspected sepsis a multiplex-PCR (LightCycler SeptiFast MGRADE-test®) was performed from 100 μl EDTA blood in addition to center-specific laboratory biomarkers. The attending neonatologist documented whether the PCR-result, which was available after 24 to 48 hrs, had an impact on the choice of antibiotic drugs and duration of therapy. Results PCR was positive in 110/214 episodes (51%) and blood culture (BC) was positive in 55 episodes (26%). Both methods yielded predominantly coagulase-negative staphylococci (CoNS) followed by Escherichia coli and Staphylococcus aureus. In 214 BC—PCR paired samples concordant results were documented in 126 episodes (59%; n = 32 were concordant pathogen positive results, n = 94 were negative in both methods). In 65 episodes (30%) we found positive PCR results but negative BCs, with CoNS being identified in 43 (66%) of these samples. Multiplex-PCR results influenced clinical decision making in 30% of episodes, specifically in 18% for the choice of antimicrobial therapy and in 22% for the duration of antimicrobial therapy. Conclusions Multiplex-PCR results had a moderate impact on clinical management in about one third of LOS-episodes. The main advantage of multiplex-PCR was the rapid detection of pathogens from micro-volume blood samples. In VLBWI limitations include risk of contamination, lack of resistance testing and high costs. The high rate of positive PCR results in episodes of negative BC might lead to overtreatment of infants which is associated with risk of mortality, antibiotic resistance, fungal sepsis and NEC.
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Affiliation(s)
- Birte Tröger
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
- * E-mail:
| | - Christoph Härtel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Michael Dördelmann
- Department of Pediatrics at Diakonissen Hospital Flensburg, Flensburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Höhn
- Department of Pediatrics at the University of Düsseldorf, Düsseldorf, Germany
| | - Nico Hepping
- Department of Pediatrics at St. Marien Hospital Bonn, Bonn, Germany
| | - Georg Hillebrand
- Department of Pediatrics at Hospital of Itzehoe, Itzehoe, Germany
| | - Angela Kribs
- Department of Pediatrics at the University of Cologne, Cologne, Germany
| | - Janina Marissen
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Dirk Olbertz
- Neonatology Unit at Südstadt Hospital Rostock, Rostock, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Susanne Schmidtke
- Neonatology Unit at Asclepios Hospital Hamburg-Barmbek, Hamburg, Germany
| | - Jens Siegel
- Neonatology Unit at the Children´s Hospital Hannover Auf der Bult, Hannover, Germany
| | - Egbert Herting
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics at the University of Lübeck, Lübeck, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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18
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Pagel J, Hartz A, Figge J, Gille C, Eschweiler S, Petersen K, Schreiter L, Hammer J, Karsten CM, Friedrich D, Herting E, Göpel W, Rupp J, Härtel C. Regulatory T cell frequencies are increased in preterm infants with clinical early-onset sepsis. Clin Exp Immunol 2016; 185:219-27. [PMID: 27163159 DOI: 10.1111/cei.12810] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/14/2016] [Accepted: 05/01/2016] [Indexed: 12/16/2022] Open
Abstract
The predisposition of preterm neonates to invasive infection is, as yet, incompletely understood. Regulatory T cells (Tregs ) are potential candidates for the ontogenetic control of immune activation and tissue damage in preterm infants. It was the aim of our study to characterize lymphocyte subsets and in particular CD4(+) CD25(+) forkhead box protein 3 (FoxP3)(+) Tregs in peripheral blood of well-phenotyped preterm infants (n = 117; 23 + 0 - 36 + 6 weeks of gestational age) in the first 3 days of life in comparison to term infants and adults. We demonstrated a negative correlation of Treg frequencies and gestational age. Tregs were increased in blood samples of preterm infants compared to term infants and adults. Notably, we found an increased Treg frequency in preterm infants with clinical early-onset sepsis while cause of preterm delivery, e.g. chorioamnionitis, did not affect Treg frequencies. Our data suggest that Tregs apparently play an important role in maintaining maternal-fetal tolerance, which turns into an increased sepsis risk after preterm delivery. Functional analyses are needed in order to elucidate whether Tregs have potential as future target for diagnostics and therapeutics.
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Affiliation(s)
- J Pagel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Department of Infectious Diseases and Microbiology, University of Lübeck
| | - A Hartz
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - J Figge
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - C Gille
- Department of Neonatology, University of Tübingen, Tübingen, Germany
| | - S Eschweiler
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - K Petersen
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - L Schreiter
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - J Hammer
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - C M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - D Friedrich
- Department of Infectious Diseases and Microbiology, University of Lübeck
| | - E Herting
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - W Göpel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - J Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck
| | - C Härtel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
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19
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20
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Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units. Adv Med Sci 2016; 61:90-5. [PMID: 26583299 DOI: 10.1016/j.advms.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/13/2015] [Accepted: 09/10/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Late-Onset Pneumonia (LO-PNEU) is still the most important complication associated with the hospitalization of infants with very low birth weight (<1501g). The purpose of this paper is to summarize the results of an ongoing surveillance program defining LO-PNEU as associated or not associated with respiratory support in the NICU and distribution of causative pathogens from the Polish Neonatology Surveillance Network (PNSN). MATERIALS AND METHODS Surveillance of infections was conducted in the years 2009-2011 at six Polish NICUs. RESULTS The incidence was 3.1/1000 NICU patient days (pds). The mean gestational age and birth weight among infants with LO-PNEU were significantly lower. The VAP incidence was of 18.2/1000 NICU pds for mechanically ventilated (MV) infants, while the rates for those receiving only CPAP were as low as 7.7/1000 NICU pds. MV significantly increased the risk of PNEU, but MV or CPAP for <10 days did not increase the risk of LO-PNEU. Significantly associated with LO-PNEU was the use of central or peripheral venous catheters and total parenteral nutrition for longer periods. Microorganisms isolated in cases of LO-PNEU were Gram-positive cocci (53.5%) and Gram-negative rods, with predominating E. coli. Non fermentative bacilli were significantly more frequent in cases of VAP than in other cases. CONCLUSIONS Observed incidence rates associated with VAP and CPAP-PNEU, were higher than in other national surveillance systems and expressing the feasibility of lowering the risk of LO-PNEU and increasing patient safety. The incidence of pneumonia was found to be lower when using CPAP as compared to using MV.
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21
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Cailes B, Vergnano S, Kortsalioudaki C, Heath P, Sharland M. The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance. Early Hum Dev 2015; 91:613-8. [PMID: 26386612 DOI: 10.1016/j.earlhumdev.2015.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of disease in this population. Neonatal units have been identified as a common site for the development and transmission of antimicrobial-resistant pathogens, a significant issue in modern medicine. Neonatal surveillance programmes collect prospective data on infection rates and may be used to optimise therapy, benchmark practice and develop quality improvement programmes. Despite this, the number of networks is relatively few and these are largely concentrated in resource-rich nations. Furthermore, surveillance definitions may vary between programmes impairing our ability to draw comparisons between them. Better harmonisation is required between networks to ensure that they achieve their potential as a valuable tool for benchmarking of hospital-acquired infection rates between units.
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Affiliation(s)
- Benjamin Cailes
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK; Monash University, Melbourne, Australia.
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Christina Kortsalioudaki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Paul Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
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22
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Schröder C, Schwab F, Behnke M, Breier AC, Maechler F, Piening B, Dettenkofer M, Geffers C, Gastmeier P. Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance. Int J Med Microbiol 2015; 305:799-806. [PMID: 26358916 DOI: 10.1016/j.ijmm.2015.08.034] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). METHOD The epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS. RESULTS Data from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50-0.72) and 0.61 (CI95 0.52-0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64-0.76) and 0.43 (CI95 0.35-0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64-1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects. CONCLUSIONS Participating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should - if possible - be considered for infection control management and for risk adjustment in the benchmarking process.
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Affiliation(s)
- C Schröder
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany.
| | - F Schwab
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - M Behnke
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - A-C Breier
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - F Maechler
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - B Piening
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - M Dettenkofer
- Institute for Environmental Medicine and Hospital Hygiene, University Medical Centre Freiburg, Germany
| | - C Geffers
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - P Gastmeier
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
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23
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Choi JY, Kwak YG, Yoo H, Lee SO, Kim HB, Han SH, Choi HJ, Kim YK, Kim SR, Kim TH, Lee H, Chun HK, Kim JS, Eun BW, Kim DW, Koo HS, Bae GR, Lee K. Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System. J Hosp Infect 2015; 91:28-34. [PMID: 26149593 DOI: 10.1016/j.jhin.2015.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of continuous nationwide surveillance on healthcare-associated infections should be investigated in each country. AIM To assess the rate of device-associated infections (DAIs) in intensive care units (ICUs) since the establishment of the Korean Nosocomial Infections Surveillance System (KONIS). METHODS Nationwide data were obtained on the incidence rate of DAI in ICUs reported to KONIS by all participating hospitals. The three major DAIs were studied: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CABSI), and catheter-associated urinary tract infection (CAUTI). The pooled and year-wise incidence rates (cases per 1000 device-days) of these DAIs were determined for the period 2006 and 2012. In addition, data from institutions that had participated in KONIS for at least three consecutive years were analysed separately. FINDINGS The number of ICUs participating in KONIS gradually increased from 76 in 2006 to 162 in 2012. Between 2006 and 2012, the incidence rate per 1000 device-days for VAP decreased significantly from 3.48 to 1.64 (F = 11, P < 0.01), for CAUTI the rate decreased non-significantly from 1.85 to 1.26 (F = 2.02, P = 0.07), and for CABSI the rate also decreased non-significantly from 3.4 to 2.57 (F = 1.73, P = 0.12). In the 132 ICUs that had participated in KONIS for at least three consecutive years, the VAP rate significantly decreased from the first year to third year (F = 20.57, P < 0.01), but the rates of CAUTI (F = 1.06, P = 0.35) and CABSI (F = 1.39, P = 0.25) did not change significantly. CONCLUSION The decreased incidence rate of VAP in ICUs in Korea might be associated with the continuous prospective surveillance provided by KONIS.
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Affiliation(s)
- J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - H Yoo
- Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - S-O Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - H B Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - S H Han
- Department of Infection Prevention and Control, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - H J Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Y K Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - S R Kim
- Infection Control Office, Korea University Guro Hospital, Seoul, South Korea
| | - T H Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - H Lee
- Department of Laboratory Medicine, Kwandong University College of Medicine, Gangneung, South Korea
| | - H K Chun
- Department of Infection Control, Kyunghee University Hospital, Seoul, South Korea
| | - J-S Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - B W Eun
- Department of Pediatrics, Eulji University School of Medicine, Eulji General Hospital, Seoul, South Korea
| | - D W Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Ilsan, South Korea
| | - H-S Koo
- Division of Infectious Disease Control, Korea Centers for Disease Control & Prevention, Osong, South Korea
| | - G-R Bae
- Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, South Korea
| | - K Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network. PLoS One 2015; 10:e0122564. [PMID: 25856083 PMCID: PMC4391753 DOI: 10.1371/journal.pone.0122564] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/23/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM) as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW) infants < 32 weeks of gestation. DESIGN Observational, epidemiological study design. SETTING Population-based cohort, German Neonatal Network (GNN). POPULATION 6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome) or placental abruption as cause of preterm birth). METHODS Multivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age. RESULTS PPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03) but not with other major outcomes. CONCLUSIONS The diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.
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Arnts IJJ, Schrijvers NM, van der Flier M, Groenewoud JMM, Antonius T, Liem KD. Central line bloodstream infections can be reduced in newborn infants using the modified Seldinger technique and care bundles of preventative measures. Acta Paediatr 2015; 104:e152-7. [PMID: 25545676 DOI: 10.1111/apa.12915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Abstract
AIM There has been no evidence to show whether care bundles of preventive measures reduce central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters using the modified Seldinger technique, which requires more specific skills than the traditional technique. The aim of this study was to address that gap in our knowledge and to determine whether other variables influenced the outcome. METHODS This prospective observational study was conducted on a neonatal intensive care unit. We observed the incidence of CLABSI in 45 newborn infants with peripheral catheters before the introduction of bundles of preventative measures and 88 infants after the introduction. RESULTS Laboratory-confirmed CLABSI decreased after the introduction of the bundles, from 12.9 per 1000 days to 4.7/1000 days (p = 0.09). When we combined the rates for laboratory-confirmed CLABSI and clinical CLABSI in a survival analysis, the incidence reduced significantly after introduction of the bundles (p = 0.02). There were no other variables that affected the outcome. CONCLUSION Cost-effective care bundles reduced CLABSI in peripherally inserted central catheters using the modified Seldinger technique, despite the specific insertion skills that were required. The bundles of preventative measures may increase healthcare professionals' awareness of the need to care for central catheters and reduce CLABSI infections.
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Affiliation(s)
- IJJ Arnts
- Department of Neonatology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - NM Schrijvers
- Department of Neonatology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - M van der Flier
- Department of Pediatrics, and Nijmegen Institute for Infection, Inflammation and Immunity; Radboud University Medical Centre; Nijmegen The Netherlands
| | - JMM Groenewoud
- Department for Health Evidence; Radboud University Medical Centre; Nijmegen The Netherlands
| | - T Antonius
- Department of Neonatology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - KD Liem
- Department of Neonatology; Radboud University Medical Centre; Nijmegen The Netherlands
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Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B, Magiorakos AP, Pittet D. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. THE LANCET. INFECTIOUS DISEASES 2015; 15:212-24. [DOI: 10.1016/s1473-3099(14)70854-0] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Wójkowska-Mach J, Gulczyńska E, Nowiczewski M, Borszewska-Kornacka M, Domańska J, Merritt TA, Helwich E, Kordek A, Pawlik D, Gadzinowski J, Szczapa J, Adamski P, Sulik M, Klamka J, Brzychczy-Włoch M, Heczko PB. Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009-2011. BMC Infect Dis 2014; 14:339. [PMID: 24939563 PMCID: PMC4074408 DOI: 10.1186/1471-2334-14-339] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/09/2014] [Indexed: 12/02/2022] Open
Abstract
Background Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011. Methods The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS. Results Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%). Conclusions Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.
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Affiliation(s)
- Jadwiga Wójkowska-Mach
- Microbiology, Jagiellonian University Medical College, 18 Czysta Street, Krakow 31-121, Poland.
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Geffers C, Haller S, Heller G, Gortner L, Göpel W, Bührer C. Nosokomiale Infektionen bei Neugeborenen. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-013-2967-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Genotypic study documents divergence in the pathogenesis of bloodstream infection related central venous catheters in neonates. Braz J Infect Dis 2014; 18:387-93. [PMID: 24690430 PMCID: PMC9427472 DOI: 10.1016/j.bjid.2013.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/15/2013] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the pathogenesis of bloodstream infection by Staphylococcus epidermidis, using the molecular epidemiology, in high-risk neonates. Methods We conducted a prospective study of a cohort of neonates with bloodstream infection using central venous catheters for more than 24 h. “National Healthcare Safety Network” surveillance was conducted. Genotyping was performed by DNA fingerprinting and mecA genes and icaAD were detected by multiplex-PCR. Results From April 2006 to April 2008, the incidence of bloodstream infection and central venous catheter-associated bloodstream infection was 15.1 and 13.0/1000 catheter days, respectively, with S. epidermidis accounting for 42.9% of episodes. Molecular analysis was used to document the similarity among six isolates of bloodstream infection by S. epidermidis from cases with positive blood and central venous catheter tip cultures. Fifty percent of neonates had bloodstream infection not identified as definite or probable central venous catheter-related bloodstream infection. Only one case was considered as definite central venous catheter-related bloodstream infection and was extraluminally acquired; the remaining were considered probable central venous catheter-related bloodstream infections, with one probable extraluminally and another probable intraluminally acquired bloodstream infection. Additionally, among mecA+ and icaAD+ samples, one clone (A) was predominant (80%). A polyclonal profile was found among sensitive samples that were not carriers of the icaAD gene. Conclusions The majority of infections caused by S. epidermidis in neonates had an unknown origin, although 33.3% appeared to have been acquired intraluminally and extraluminally. We observed a polyclonal profile between sensitive samples and a prevalent clone (A) between resistant samples.
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Verstraete E, Boelens J, De Coen K, Claeys G, Vogelaers D, Vanhaesebrouck P, Blot S. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol 2014; 35:511-8. [PMID: 24709719 DOI: 10.1086/675836] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011). DESIGN Historical cohort study. SETTING Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital. PATIENTS Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD). METHODS A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis. RESULTS In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001). CONCLUSIONS An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.
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Affiliation(s)
- Evelien Verstraete
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Arnts IJJ, Bullens LM, Groenewoud JMM, Liem KD. Comparison of Complication Rates Between Umbilical and Peripherally Inserted Central Venous Catheters in Newborns. J Obstet Gynecol Neonatal Nurs 2014; 43:205-15. [DOI: 10.1111/1552-6909.12278] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network. Pediatr Infect Dis J 2014; 33:238-43. [PMID: 24030351 DOI: 10.1097/inf.0000000000000031] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It was the aim of this study to assess whether very-low-birth-weight (VLBW) infants born small for gestational age (SGA; birth weight less than 10th percentile) are at increased risk for late-onset sepsis. METHODS This was a prospective, multicenter study of the German Neonatal Network including VLBW infants from 23 to < 32 weeks post menstrual age born 2009-2011. Outcomes were compared between VLBW infants born SGA (birth weight less than tenth percentile according to gestational age and gender) and non-SGA infants. The main outcome measure was at least 1 episode of late-onset sepsis defined as blood-culture-confirmed clinical sepsis occurring at ≥ 72 hours of age. RESULTS 5886 VLBW infants were included. In SGA infants (n = 692), an increased incidence of late-onset sepsis was noted compared with non-SGA infants (20.1% vs. 14.3 %, P < 0.001). This difference was only observed among infants with a gestational age of 27 to < 32 weeks and attributed to sepsis episodes with coagulase-negative staphylococci (12.8% vs. 8.3%, P < 0.001). Different treatment modalities (eg more frequent use of central venous lines) and longer duration of invasive therapies (parenteral nutrition, mechanical ventilation, hospitalization) may account for the increased sepsis risk with coagulase-negative staphylococci in our SGA cohort. In a multivariate logistic regression analysis, higher gestational age [per week; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.72-0.78, P< 0.0001], treatment with antenatal steroids (OR: 0.7, 95% CI: 0.53-0.92, P = 0.01), German descendance (OR: 0.76, 95% CI: 0.63-0.91, P = 0.003) and prophylaxis with glycopeptide antibiotics (OR: 0.64, 95% CI: 0.47-0.87, P = 0.005) were shown to be protective against late-onset sepsis. In contrast, longer duration of parenteral nutrition (per day; OR: 1.016, 95% CI: 1.011-1.021, P < 0.0001) and SGA were found to be risk factors (OR: 1.31, 95% CI: 1.02-1.68, P= 0.03). CONCLUSIONS SGA contributes to the risk of late-onset sepsis in VLBW infants. Future studies are needed to investigate the underlying pathophysiology to guide individualized preventive measures in this vulnerable subgroup.
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Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010. Pediatr Res 2013; 74 Suppl 1:73-85. [PMID: 24366464 PMCID: PMC3873707 DOI: 10.1038/pr.2013.207] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Survivors of neonatal infections are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified and yet important for program priority setting. Systematic reviews and meta-analyses were undertaken and applied in a three-step compartmental model to estimate NDI cases after severe neonatal bacterial infection in South Asia, sub-Saharan Africa, and Latin America in neonates of >32 wk gestation (or >1,500 g). METHODS We estimated cases of sepsis, meningitis, pneumonia, or no severe bacterial infection from among estimated cases of possible severe bacterial infection ((pSBI) step 1). We applied respective case fatality risks ((CFRs) step 2) and the NDI risk among survivors (step 3). For neonatal tetanus, incidence estimates were based on the estimated deaths, CFRs, and risk of subsequent NDI. RESULTS For 2010, we estimated 1.7 million (uncertainty range: 1.1-2.4 million) cases of neonatal sepsis, 200,000 (21,000-350,000) cases of meningitis, 510,000 cases (150,000-930,000) of pneumonia, and 79,000 cases (70,000-930,000) of tetanus in neonates >32 wk gestation (or >1,500 g). Among the survivors, we estimated moderate to severe NDI after neonatal meningitis in 23% (95% confidence interval: 19-26%) of survivors, 18,000 (2,700-35,000) cases, and after neonatal tetanus in 16% (6-27%), 4,700 cases (1,700-8,900). CONCLUSION Data are lacking for impairment after neonatal sepsis and pneumonia, especially among those of >32 wk gestation. Improved recognition and treatment of pSBI will reduce neonatal mortality. Lack of follow-up data for survivors of severe bacterial infections, particularly sepsis, was striking. Given the high incidence of sepsis, even minor NDI would be of major public health importance. Prevention of neonatal infection, improved case management, and support for children with NDI are all important strategies, currently receiving limited policy attention.
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Gastmeier P, Behnke M, Breier AC, Piening B, Schwab F, Dettenkofer M, Geffers C. [Healthcare-associated infection rates: measuring and comparing. Experiences from the German National Nosocomial Infection Surveillance System (KISS) and from other surveillance systems]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1363-9. [PMID: 23114434 DOI: 10.1007/s00103-012-1551-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surveillance of nosocomial infections is meanwhile a cornerstone of infection prevention activities in hospitals. The objective of this article is to compare healthcare-associated infection rates in intensive care patients, neonatal intensive care patients and operated patients (ICU-KISS, OP-KISS, NEO-KISS) of the German nosocomial infection surveillance system (KISS) with the corresponding data of the US American National Healthcare Safety Network (NHSN) and the European Centre for Disease Prevention and Control (ECDC). In general, the methodological differences among the three surveillance systems are minor but there are some exceptions. Therefore, differences between countries have to be interpreted very carefully as they may be due to differences in diagnostics, patient mix, types of interventions, length of stay, selection of participating hospitals, post-discharge surveillance activities and interpretation of case definitions. Organizational aspects, such as mandatory participation with public disclosure on infection rates may also have an impact.
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Affiliation(s)
- P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité- Universitätsmedizin Berlin, Hindenburgdamm 27, Berlin, Germany.
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Pandolfini C, Marco S, Paolo M, Maurizio B. The use of ciprofloxacin and fluconazole in Italian neonatal intensive care units: a nationwide survey. BMC Pediatr 2013; 13:5. [PMID: 23294560 PMCID: PMC3546886 DOI: 10.1186/1471-2431-13-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment and prophylaxis of sepsis in very low birth weight neonates is a matter of concern and research is being undertaken with the aim to give rise to shared approaches based on solid evidence. As part of a European initiative, a survey was set up to describe the use of two drugs in this area. The Italian national practices concerning neonatal sepsis, as well as calls for related guidance, are described. METHODS A standardized and previously tested questionnaire was submitted online to all Italian level III NICUs. A 5-point Likert scale was used to analyze attitudinal replies. Categorical variables were compared by χ2 analysis and 2-tailed P-values are reported. RESULTS Data was provided by 38 Italian NICUs (36% of the country's level III centers), 53% of which have 1-10 cases of bacterial sepsis monthly and 90% a prevalence of <1% fungal infections. Ciprofloxacin and fluconazole treatment for neonatal sepsis are scantly used in Italian NICUs (13% and 45%, respectively). Major concerns are related to the safety of ciprofloxacin and the efficacy of fluconazole. On the contrary, prophylaxis of fungal infections is a routine approach in many Italian NICUs. The use of both ciprofloxacin and fluconazole is characterized by a large inter-NICU variability in dose and scheme of use. The lack of adequate, shared evidence is a common consideration made by the survey participants. CONCLUSIONS Common approaches are needed to standardize and update a national drug strategy for the prevention and treatment of sepsis in very low birth weight newborns. This can be achieved through collaborative initiatives aimed at setting up guidelines, based on available data, and multicenter trials to produce new evidence that will address the knowledge gaps.
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Affiliation(s)
- Chiara Pandolfini
- Laboratory for Mother and Child Health, Department of Public Health “Mario Negri” Pharmacological Research Institute, Milan, Italy
| | - Sequi Marco
- Laboratory for Mother and Child Health, Department of Public Health “Mario Negri” Pharmacological Research Institute, Milan, Italy
| | - Manzoni Paolo
- Neonatology and Hospital Neonatal Intensive Care Unit, Azienda Ospedaliera Regina Margherita – Sant’Anna, Turin, Italy
| | - Bonati Maurizio
- Laboratory for Mother and Child Health, Department of Public Health “Mario Negri” Pharmacological Research Institute, Milan, Italy
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Chang YS, Park WS. Strategies to Overcome the Limit of Viability of Microprimie. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.3.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic.
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L’Hériteau F, Lacavé L, Leboucher B, Decousser JW, De Chillaz C, Astagneau P, Aujard Y. Surveillance en réseau des bactériémies sur cathéter en néonatologie : résultats 2010 du réseau NEOCAT. Arch Pediatr 2012; 19:984-9. [DOI: 10.1016/j.arcped.2012.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
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Epidemic microclusters of blood-culture proven sepsis in very-low-birth weight infants: experience of the German Neonatal Network. PLoS One 2012; 7:e38304. [PMID: 22768043 PMCID: PMC3387163 DOI: 10.1371/journal.pone.0038304] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/07/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction We evaluated blood culture-proven sepsis episodes occurring in microclusters in very-low-birth-weight infants born in the German Neonatal Network (GNN) during 2009–2010. Methods Thirty-seven centers participated in GNN; 23 centers enrolled ≥50 VLBW infants in the study period. Data quality was approved by on-site monitoring. Microclusters of sepsis were defined as occurrence of at least two blood-culture proven sepsis events in different patients of one center within 3 months with the same bacterial species. For microcluster analysis, we selected sepsis episodes with typically cross-transmitted bacteria of high clinical significance including gram-negative rods and Enterococcus spp. Results In our cohort, 12/2110 (0.6%) infants were documented with an early-onset sepsis and 235 late-onset sepsis episodes (≥72 h of age) occurred in 203/2110 (9.6%) VLBW infants. In 182/235 (77.4%) late-onset sepsis episodes gram-positive bacteria were documented, while coagulase negative staphylococci were found to be the most predominant pathogens (48.5%, 95%CI: 42.01–55.01). Candida spp. and gram-negative bacilli caused 10/235 (4.3%, 95%CI: 1.68% –6.83%) and 43/235 (18.5%) late-onset sepsis episodes, respectively. Eleven microclusters of blood-culture proven sepsis were detected in 7 hospitals involving a total 26 infants. 16/26 cluster patients suffered from Klebsiella spp. sepsis. The median time interval between the first patient’s Klebsiella spp. sepsis and cluster cases was 14.1 days (interquartile range: 1–27 days). First patients in the cluster, their linked cases and sporadic sepsis events did not show significant differences in short term outcome parameters. Discussion Microclusters of infection are an important phenomenon for late-onset sepsis. Most gram-negative cluster infections occur within 30 days after the first patient was diagnosed and Klebsiella spp. play a major role. It is essential to monitor epidemic microclusters of sepsis in surveillance networks to adapt clinical practice, inform policy and further improve quality of care.
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Schwab F, Gastmeier P, Piening B, Geffers C. The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect. Antimicrob Resist Infect Control 2012; 1:24. [PMID: 22958509 PMCID: PMC3489557 DOI: 10.1186/2047-2994-1-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/15/2012] [Indexed: 12/03/2022] Open
Abstract
Abstract Background The German national nosocomial infection surveillance system, KISS, has a component for very low birth weight (VLBW) infants (called NEO-KISS) which changed from a system with voluntary participation and confidential data feedback to a system with mandatory participation and confidential feedback. Methods In order to compare voluntary and mandatory surveillance data, two groups were defined by the surveillance start date. Neonatal intensive care unit (NICU) parameters and infection rates of the NICUs in both groups were compared. In order to analyze the surveillance effect on primary bloodstream infection rates (BSI), all VLBW infants within the first three years of participation in both groups were considered. The adjusted effect measures for the year of participation were calculated. Results An increase from 49 NICUs participating in 2005 to 152 in 2006 was observed after the introduction of mandatory participation. A total of 4280 VLBW infants was included in this analysis. Healthcare-associated incidence densities rates were similar in both groups. Using multivariate analysis with the endpoint primary BSI rate and comparing the first and third year of participation lead to an adjusted incidence rate ratio (IRR) of 0.78 (CI95 0.66-0.93) for old (voluntary) and 0.81 (CI95 0.68-0.97) for new (mandatory) participants. Conclusions The step from a voluntary to a mandatory HCAI surveillance system alone may lead to substantial improvements on a countrywide scale.
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Affiliation(s)
- Frank Schwab
- National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany.
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Payne NR, Barry J, Berg W, Brasel DE, Hagen EA, Matthews D, McCullough K, Sanger K, Steger MD. Sustained reduction in neonatal nosocomial infections through quality improvement efforts. Pediatrics 2012; 129:e165-73. [PMID: 22144702 DOI: 10.1542/peds.2011-0566] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although reports of reduced nosocomial infections (NI) in very low birth weight infants have been published, the durability of these gains and changes in secondary outcomes, and clinical practices have less often been published. METHODS This was a retrospective, observational study of NI reduction in very low birth weight infants at two hospital campuses. The intervention began in 2005 with our renewed quality improvement efforts to reduce NI. We compared outcomes before (2000-2005) and after (2006-2009) the intervention by using univariate and multiple regression analyses. RESULTS We reduced NI by 50% comparing 2000-2005 to 2006-2009 (23.6% vs 11.6%, P < .001). Adjusting for covariates, the odds ratio for NI was 0.33 (confidence interval, 0.26 - 0.42, P < .001) in the more recent era. NI were lower even in infants with birth weight 501-1000 grams (odds ratio = 0.38, confidence interval, 0.29 - 0.51, P < .001). We also reduced bronchopulmonary dysplasia (30.2% vs 25.5%, P = .001), median days to regain birth weight (9 vs 8, P = .04), percutaneously placed central venous catheter use (54.8% vs 43.9%, P = .002), median antibiotic days (8 vs 6, P = .003), median total central line days (16 vs 15, P = .01), and median ventilator days (7 vs 5, P = .01). We sustained improvements for three years. CONCLUSIONS Quality improvement efforts were associated with sustained reductions in NI, bronchopulmonary dysplasia, antibiotic use, central line use, and ventilator days.
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Affiliation(s)
- Nathaniel R Payne
- Department of Quality and Safety, Children's Hospital & Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA.
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de Oliveira A, Sanches P, Lyra JC, Bentlin MR, Rugolo LMSS, de Lourdes Ribeiro de Souza da Cunha M. Risk factors for infection with coagulase-negative staphylococci in newborns from the neonatal unit of a brazilian university hospital. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2011; 6:1-9. [PMID: 23641161 PMCID: PMC3620778 DOI: 10.4137/cmped.s7427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Coagulase-negative staphylococci (CoNS) are one of the most frequent causative agents of neonatal nosocomial infections, especially in premature and low-weight newborns. Risk factors for infection include extracellular polysaccharide production and consequent biofilm formation that permit adhesion to the smooth surface of catheters and other medical devices. The objective of this study was to identify CoNS strains isolated from 105 newborns admitted to the Neonatal Unit of our hospital, and to evaluate the association of biofilm production and host risk factors with the occurrence of infection. Methods: CoNS isolates were identified and classified as significant or contaminant based on clinical and laboratory data of the newborn medical records. Perinatal risk factors for infection, neonatal clinical evolution, and antibiotic treatment were analysed. In addition, the presence of genes (icaA, icaC and icaD) responsible for biofilm production in CoNS was investigated. Results: Among the 130 CoNS strains studied, 66 (50.8%) were classified as clinically significant and 64 (49.2%) as contaminant. There was no difference in the detection of biofilm-specific genes between CoNS strains isolated from newborns with (81.8%) and without infection (84.3%), although 11 (91.7%) of the 12 children whose death was related to CoNS were infected with strains that were positive for these genes. Forty-five (83.3%) of the 54 newborns infected with CoNS were premature and 33 (61.1%) had a birth weight ≤ 1,500 g. Most newborns infected with CoNS had been submitted to invasive procedures, including catheter use (85.2%), parenteral nutrition (61.1%), and mechanical ventilation (57.4%). S. epidermidis was the most frequently isolated species (81.5%) and was more related to infection (86.3%) than to contamination (76.5%). Conclusion: Most newborns infected with CoNS presented factors that contributed to the colonization and development of infection with these microorganisms, including a birth weight ≤ 1,500 g, catheter complications, use of a drain, and previous antibiotic treatment. The fact that most children who died of CoNS-related infection carried strains positive for biofilm-specific genes indicates the importance of this virulence factor for the outcome of staphylococcal infections.
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Affiliation(s)
- Adilson de Oliveira
- Department of Microbiology and Immunology, Institute of Biosciences, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Lee JH. Catheter-related bloodstream infections in neonatal intensive care units. KOREAN JOURNAL OF PEDIATRICS 2011; 54:363-7. [PMID: 22232628 PMCID: PMC3250601 DOI: 10.3345/kjp.2011.54.9.363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022]
Abstract
Central venous catheters (CVCs) are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI) remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs) include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI) with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci, and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.
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Affiliation(s)
- Jung Hyun Lee
- Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea
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Brito DVD, Brito CSD, Resende DS, Moreira do Ó J, Abdallah VOS, Gontijo Filho PP. Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study. Rev Soc Bras Med Trop 2011; 43:633-7. [PMID: 21181013 DOI: 10.1590/s0037-86822010000600006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/20/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the NICU of the Uberlândia University Hospital. METHODS Data were collected through the National Healthcare Safety Network surveillance from January 2006 to December 2009. The patients were followed five times/week from their birth to their discharge or death. RESULTS The study included 1,443 patients, 209 of these developed NIs, totaling 293 NI episodes, principally bloodstream infections (203; 69.3%) and conjunctivitis (52; 17.7%). Device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonias per 1000 ventilator-days. The mortality rate in neonates with NI was 11.9%. Mechanical ventilation, total parenteral nutrition, orogastric tube, previous antibiotic therapy, use of CVC and birth weight of 751-1,000g appeared to be associated with a significantly higher risk of NI (p < 0.05). In multiple logistic regression analysis for NI, mechanical ventilation and the use of CVC were independent risk factors (p < 0.05). Coagulase- negative Staphylococcus (CoNS) (36.5%) and Staphylococcus aureus (23.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and S. aureus were 81.8% and 25.3%, respectively. CONCLUSIONS Frequent surveillance was very important to evaluate the association of these well-known risk factors with NIs and causative organisms, assisting in drawing the attention of health care professionals to this potent cause of morbidity.
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Affiliation(s)
- Denise Von Dollinger Brito
- Microbiology Laboratory, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Gastmeier P, Behnke M, Reichardt C, Geffers C. [Quality management for preventing healthcare-acquired infections. The importance of surveillance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:207-12. [PMID: 21290275 DOI: 10.1007/s00103-010-1200-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.
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Affiliation(s)
- P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin und Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Hindenburgdamm 27, Berlin, Germany.
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Gastmeier P, Behnke M, Schwab F, Geffers C. Benchmarking of urinary tract infection rates: experiences from the intensive care unit component of the German national nosocomial infections surveillance system. J Hosp Infect 2011; 78:41-4. [DOI: 10.1016/j.jhin.2011.01.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 01/26/2011] [Indexed: 01/09/2023]
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Gill A, Keil A, Jones C, Aydon L, Biggs S. Tracking neonatal nosocomial infection: the continuous quality improvement cycle. J Hosp Infect 2011; 78:20-5. [DOI: 10.1016/j.jhin.2010.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
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Barbadoro P, Marigliano A, D'Errico MM, Carnielli V, Prospero E. Gestational age as a single predictor of health care-associated bloodstream infections in neonatal intensive care unit patients. Am J Infect Control 2011; 39:159-62. [PMID: 21050625 DOI: 10.1016/j.ajic.2010.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/22/2010] [Accepted: 03/29/2010] [Indexed: 02/05/2023]
Abstract
Neonates rank among those at highest risk for health care-associated bloodstream infections (BSIs), which are linked to high morbidity and mortality rates. The importance of surveillance in preventing BSIs has been reported; however, a comparison of rates between different institution depends on methods used for risk adjustment and on factors identified as associated with infection. The present study aimed to compare the effectiveness of different stratification models in identifying neonates at risk for health care-associated sepsis. An observational prospective study was performed. The effectiveness of risk stratification models was assessed by receiver operating characteristic analysis. Our findings suggest the potential role of gestational age as a simple classification criteria for identifying patients at risk for BSI.
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Affiliation(s)
- Pamela Barbadoro
- Department of Biomedical Science, Section of Hygiene, Polytechnic University of the Marches, Via Tronto 10/A, Ancona, Italy.
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Secular trends of healthcare-associated infections at a teaching hospital in Taiwan, 1981-2007. J Hosp Infect 2010; 76:143-9. [PMID: 20663585 PMCID: PMC7114588 DOI: 10.1016/j.jhin.2010.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 05/07/2010] [Indexed: 12/03/2022]
Abstract
The National Taiwan University Hospital (NTUH) adopted international guidelines for surveillance and control of healthcare-associated infection (HCAI) in 1981. This report describes the secular trends in HCAI at the NTUH over the past 27 years according to site of infection, aetiological agents and control measures. Clinical and microbiological data were collected by infection prevention and control nurses using a standardised case-record form. Specific control programmes were implemented and/or intensified as needed. Poisson or negative binomial regression analysis was used to quantify time trends of the incidence of HCAI. The annual number of discharges increased from 25 074 to 91 234 with a parallel increase in the Charlson comorbidity index. Active HCAI surveillance and periodic feedback were associated with a marked decrease in surgical site infections from 1981 to 2007 (2.5 vs 0.5 episodes per 100 procedures, P < 0.0001). On the other hand, there was a 4.8-fold increase in bloodstream infections (BSIs) (0.39 vs 1.88 episodes per 100 discharges, P < 0.0001). The average annual increase of pathogen-specific HCAI incidence during 1981–2007 was 11.4% for meticillin-resistant Staphylococcus aureus (MRSA), 75.4% for extensively drug-resistant A. baumannii (XDRAB), and 7.5% for Candida albicans (P < 0.0001, respectively). The infection prevention and control programme was upgraded in 2004 by implementing annual, intensive, project-based control programmes, and decreases in rates of HCAI, BSI, MRSA and XDRAB were observed. This long term study demonstrates the need to couple surveillance of HCAI with focused control programmes. Hospitals must invest in adequate manpower to accomplish these goals.
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Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2010; 32:42-9. [PMID: 21121817 DOI: 10.1086/657634] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To monitor trends in central line-associated bloodstream infections and clinical sepsis (CLABICS) among neonates and to determine risk factors for infection, especially dwell time. DESIGN Prospective, single-center cohort study conducted from 2001 through 2008. SETTING University-affiliated tertiary care center. METHODS Individualized surveillance of catheter use and CLABICS episodes was conducted. Data were obtained via regular on-site visits made 3 times a week. Trends over time were estimated by Poisson regression, and risk factor analysis was conducted using a Cox proportional hazards model and logistic regression. RESULTS In all, 1,124 neonates were exposed to 2,210 central lines for a total of 12,746 catheter-days and 11,467 catheter-days at risk. The median duration of catheter use was 8 (interquartile range, 5-11) days for peripherally inserted central catheters (PICCs) and 4 (interquartile range, 2-6) days for umbilical catheters; 102 CLABICS episodes were detected. The median time to infection was 7 days. Incidence densities were 8.5 CLABICS episodes per 1,000 catheter-days at risk and 8.0 CLABICS episodes per 1,000 catheter-days. The highest rates were identified among neonates weighing 750 g or lower (14.9 CLABICS episodes per 1,000 catheter days at risk) and for PICCs (13.2 CLABICS episodes per 1,000 catheter days at risk). Catheter dwell time was associated with CLABICS for all umbilical catheters (odds ratio [OR], 1.2 per day of use [95% confidence interval {CI}, 1.1-1.3]; P < .001) and for PICCs for up to 7 days (OR, 1.2 [95% CI, 1.1-1.4]; P = .041), but not thereafter (OR, 1.0 [95% CI, 0.9-1.1]; P = .90). CONCLUSION Catheter dwell time is a risk factor for CLABICS during the first 7 days, irrespective of catheter type. After 7 days, PICCs are less likely to become infected.
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Affiliation(s)
- Walter Zingg
- University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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