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Mullin K, Rentea RM, Appleby M, Reeves PT. Gastrointestinal Ostomies in Children: A Primer for the Pediatrician. Pediatr Rev 2024; 45:210-224. [PMID: 38556505 DOI: 10.1542/pir.2023-006195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Despite the advancement of medical therapies in the care of the preterm neonate, in the management of short bowel syndrome and the control of pediatric inflammatory bowel disease, the need to create fecal ostomies remains a common, advantageous treatment option for many medically complex children.
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Affiliation(s)
- Kaitlyn Mullin
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital-Kansas City, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Patrick T Reeves
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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2
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Felgate H, Quinn C, Richardson B, Hudson C, Sethi D, Oddie S, Clarke P, Webber MA. Impact of daily octenidine skin washing versus nonwashing on antiseptic tolerance of coagulase-negative staphylococci in two neonatal intensive care units with different skin cleansing practices. Infect Prev Pract 2024; 6:100344. [PMID: 38371886 PMCID: PMC10874753 DOI: 10.1016/j.infpip.2024.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background There is wide variation in practices regarding routine bathing/washing of babies in neonatal intensive care units (NICUs). Evidence is lacking as to the benefit of routine antiseptic washes for reducing infection. We aimed to compare the antiseptic tolerance of Coagulase Negative Staphylococci (CoNS) within two UK NICUs with very different approaches to skin washing. Methods We compared antiseptic susceptibility of CoNS isolated from skin swabs of neonates admitted to the Norfolk and Norwich University Hospital (NNUH) NICU in December 2017-March 2018 with those isolated in the Bradford Royal Infirmary (BRI) NICU in January-March 2020. The NNUH does not practise routine whole-body washing whereas BRI practises daily whole-body washing from post-menstrual age 27 weeks using Octenisan wash lotion (0.3% octenidine; 1 minute contact time before washing off with sterile water). A total of 78 CoNS isolates from BRI and 863 from the NNUH were tested for susceptibility against the antiseptics octenidine (OCT) and chlorhexidine (CHX). Results Isolates from the BRI with practice of routine washing did not show increased antiseptic tolerance to OCT or CHX. Isolates from the NNUH which does not practise routine whole-body washing and rarely uses octenidine, were comparatively less susceptible to both CHX and OCT antiseptics. Conclusions Daily whole-body skin washing with OCT does not appear to select for CoNS isolates that are antiseptic tolerant towards OCT and CHX. There remains considerable uncertainty about the impact of different antiseptic regimes on neonatal skin microbiota, the benefit of routine washing, and the development of antiseptic tolerance in the NICU.
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Affiliation(s)
- Heather Felgate
- Quadram Institute Bioscience (QIB), Norwich Research Park, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Charlotte Quinn
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Carol Hudson
- Neonatal Unit, Bradford Royal Infirmary, Bradford, UK
| | - Dheeraj Sethi
- Quadram Institute Bioscience (QIB), Norwich Research Park, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sam Oddie
- Neonatal Unit, Bradford Royal Infirmary, Bradford, UK
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Mark A. Webber
- Quadram Institute Bioscience (QIB), Norwich Research Park, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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Clarke P, Soe A, Nichols A, Harizaj H, Webber MA, Linsell L, Bell JL, Tremlett C, Muthukumar P, Pattnayak S, Partlett C, King A, Juszczak E, Heath PT. 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:202-210. [PMID: 37907266 PMCID: PMC10894828 DOI: 10.1136/archdischild-2023-325871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Catheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. To inform the feasibility and design of a definitive randomised controlled trial (RCT) of two antiseptic formulations, we conducted the Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) feasibility study to assess catheter colonisation, sepsis, and skin morbidity. DESIGN Feasibility RCT. SETTING Two UK tertiary-level neonatal intensive care units. PATIENTS Preterm infants born <34 weeks' gestation scheduled to undergo PCVC insertion. INTERVENTIONS Skin disinfection with either 2% chlorhexidine gluconate (CHG)-aqueous or 2% CHG-70% isopropyl alcohol (IPA) before PCVC insertion and at removal. PRIMARY OUTCOME Proportion in the 2% CHG-70% IPA arm with a colonised catheter at removal. MAIN FEASIBILITY OUTCOMES Rates of: (1) CRS, catheter-associated sepsis (CAS), and CRS/CAS per 1,000 PCVC days; (2) recruitment and retention; (3) data completeness. SAFETY OUTCOMES Daily skin morbidity scores recorded from catheter insertion until 48 hours post-removal. RESULTS 116 babies were randomised. Primary outcome incidence was 4.1% (95% confidence interval: 0.9% to 11.5%). Overall catheter colonisation rate was 5.2% (5/97); CRS 2.3/1000 catheter days; CAS 14.8/1000 catheter days. Recruitment, retention and data completeness were good. No major antiseptic-related skin injury was reported. CONCLUSIONS A definitive comparative efficacy trial is feasible, but the very low catheter colonisation rate would make a large-scale RCT challenging due to the very large sample size required. ARCTIC provides preliminary reassurance supporting potential safe use of 2% CHG-70% IPA and 2% CHG-aqueous in preterm neonates. TRIAL REGISTRATION NUMBER ISRCTN82571474.
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Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Aung Soe
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Amy Nichols
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Helen Harizaj
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Mark A Webber
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Quadram Institute Bioscience, Norwich, Norfolk, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Bell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Catherine Tremlett
- Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Priyadarsini Muthukumar
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Santosh Pattnayak
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Christopher Partlett
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew King
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, Infection and Immunity, Saint George's University of London, London, UK
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Zhou J, Luo F, Liang J, Cheng X, Chen X, Li L, Chen S. Construction and validation of a predictive risk model for nosocomial infections with MDRO in NICUs: a multicenter observational study. Front Med (Lausanne) 2023; 10:1193935. [PMID: 37435538 PMCID: PMC10332151 DOI: 10.3389/fmed.2023.1193935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives This study aimed to construct and validate a predictive risk model (PRM) for nosocomial infections with multi-drug resistant organism (MDRO) in neonatal intensive care units (NICUs), in order to provide a scientific and reliable prediction tool, and to provide reference for clinical prevention and control of MDRO infections in NICUs. Methods This multicenter observational study was conducted at NICUs of two tertiary children's hospitals in Hangzhou, Zhejiang Province. Using cluster sampling, eligible neonates admitted to NICUs of research hospitals from January 2018 to December 2020 (modeling group) or from July 2021 to June 2022 (validation group) were included in this study. Univariate analysis and binary logistic regression analysis were used to construct the PRM. H-L tests, calibration curves, ROC curves and decision curve analysis were used to validate the PRM. Results Four hundred and thirty-five and one hundred fourteen neonates were enrolled in the modeling group and validation group, including 89 and 17 neonates infected with MDRO, respectively. Four independent risk factors were obtained and the PRM was constructed, namely: P = 1/ (1+ e-X), X = -4.126 + 1.089× (low birth weight) +1.435× (maternal age ≥ 35 years) +1.498× (use of antibiotics >7 days) + 0.790× (MDRO colonization). A nomogram was drawn to visualize the PRM. Through internal and external validation, the PRM had good fitting degree, calibration, discrimination and certain clinical validity. The prediction accuracy of the PRM was 77.19%. Conclusion Prevention and control strategies for each independent risk factor can be developed in NICUs. Moreover, clinical staff can use the PRM to early identification of neonates at high risk, and do targeted prevention to reduce MDRO infections in NICUs.
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Affiliation(s)
- Jinyan Zhou
- Administration Department of Nosocomial Infection, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Feixiang Luo
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianfeng Liang
- Statistics Office, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoying Cheng
- Quality Improvement Office, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaofei Chen
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Linyu Li
- Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Muhd Helmi MA, Lai NM, Van Rostenberghe H, Ayub I, Mading E. Antiseptic solutions for skin preparation during central catheter insertion in neonates. Cochrane Database Syst Rev 2023; 5:CD013841. [PMID: 37142550 PMCID: PMC10158577 DOI: 10.1002/14651858.cd013841.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Central venous catheters (CVC) are associated with potentially dangerous complications such as thromboses, pericardial effusions, extravasation, and infections in neonates. Indwelling catheters are amongst the main risk factors for nosocomial infections. The use of skin antiseptics during the preparation for central catheter insertion may prevent catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). However, it is still not clear which antiseptic solution is the best to prevent infection with minimal side effects. OBJECTIVES To systematically evaluate the safety and efficacy of different antiseptic solutions in preventing CRBSI and other related outcomes in neonates with CVC. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and trial registries up to 22 April 2022. We checked reference lists of included trials and systematic reviews that related to the intervention or population examined in this Cochrane Review. SELECTION CRITERIA: Randomised controlled trials (RCTs) or cluster-RCTs were eligible for inclusion in this review if they were performed in the neonatal intensive care unit (NICU), and were comparing any antiseptic solution (single or in combination) against any other type of antiseptic solution or no antiseptic solution or placebo in preparation for central catheter insertion. We excluded cross-over trials and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used the standard methods from Cochrane Neonatal. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included three trials that had two different comparisons: 2% chlorhexidine in 70% isopropyl alcohol (CHG-IPA) versus 10% povidone-iodine (PI) (two trials); and CHG-IPA versus 2% chlorhexidine in aqueous solution (CHG-A) (one trial). A total of 466 neonates from level III NICUs were evaluated. All included trials were at high risk of bias. The certainty of the evidence for the primary and some important secondary outcomes ranged from very low to moderate. There were no included trials that compared antiseptic skin solutions with no antiseptic solution or placebo. CHG-IPA versus 10% PI Compared to PI, CHG-IPA may result in little to no difference in CRBSI (risk ratio (RR) 1.32, 95% confidence interval (CI) 0.53 to 3.25; risk difference (RD) 0.01, 95% CI -0.03 to 0.06; 352 infants, 2 trials, low-certainty evidence) and all-cause mortality (RR 0.88, 95% CI 0.46 to 1.68; RD -0.01, 95% CI -0.08 to 0.06; 304 infants, 1 trial, low-certainty evidence). The evidence is very uncertain about the effect of CHG-IPA on CLABSI (RR 1.00, 95% CI 0.07 to 15.08; RD 0.00, 95% CI -0.11 to 0.11; 48 infants, 1 trial; very low-certainty evidence) and chemical burns (RR 1.04, 95% CI 0.24 to 4.48; RD 0.00, 95% CI -0.03 to 0.03; 352 infants, 2 trials, very low-certainty evidence), compared to PI. Based on a single trial, infants receiving CHG-IPA appeared less likely to develop thyroid dysfunction compared to PI (RR 0.05, 95% CI 0.00 to 0.85; RD -0.06, 95% CI -0.10 to -0.02; number needed to treat for an additional harmful outcome (NNTH) 17, 95% CI 10 to 50; 304 infants). Neither of the two included trials assessed the outcome of premature central line removal or the proportion of infants or catheters with exit-site infection. CHG-IPA versus CHG-A The evidence suggests CHG-IPA may result in little to no difference in the rate of proven CRBSI when applied on the skin of neonates prior to central line insertion (RR 0.80, 95% CI 0.34 to 1.87; RD -0.05, 95% CI -0.22 to 0.13; 106 infants, 1 trial, low-certainty evidence) and CLABSI (RR 1.14, 95% CI 0.34 to 3.84; RD 0.02, 95% CI -0.12 to 0.15; 106 infants, 1 trial, low-certainty evidence), compared to CHG-A. Compared to CHG-A, CHG-IPA probably results in little to no difference in premature catheter removal (RR 0.91, 95% CI 0.26 to 3.19; RD -0.01, 95% CI -0.15 to 0.13; 106 infants, 1 trial, moderate-certainty evidence) and chemical burns (RR 0.98, 95% CI 0.47 to 2.03; RD -0.01, 95% CI -0.20 to 0.18; 114 infants, 1 trial, moderate-certainty evidence). No trial assessed the outcome of all-cause mortality and the proportion of infants or catheters with exit-site infection. AUTHORS' CONCLUSIONS Based on current evidence, compared to PI, CHG-IPA may result in little to no difference in CRBSI and mortality. The evidence is very uncertain about the effect of CHG-IPA on CLABSI and chemical burns. One trial showed a statistically significant increase in thyroid dysfunction with the use of PI compared to CHG-IPA. The evidence suggests CHG-IPA may result in little to no difference in the rate of proven CRBSI and CLABSI when applied on the skin of neonates prior to central line insertion. Compared to CHG-A, CHG-IPA probably results in little to no difference in chemical burns and premature catheter removal. Further trials that compare different antiseptic solutions are required, especially in low- and middle-income countries, before stronger conclusions can be made.
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Affiliation(s)
- Muhd Alwi Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Izzudeen Ayub
- Department of Paediatrics, Hospital Pengajar Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Emie Mading
- Faculty of Medicine and Health Sciences, University Malaysia Sabah (UMS), Sabah, Malaysia
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Hitaka D, Fujiyama S, Nishihama Y, Ishii R, Hoshino Y, Hamada H, Miyazono Y, Nakayama SF, Takada H. Assessment of Alcohol Exposure From Alcohol-Based Disinfectants Among Premature Infants in Neonatal Incubators in Japan. JAMA Netw Open 2023; 6:e230691. [PMID: 36826814 PMCID: PMC9958524 DOI: 10.1001/jamanetworkopen.2023.0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
IMPORTANCE The risk of premature infants in neonatal incubators exposed to evaporated alcohol from alcohol-based disinfectants (ABDs) is unknown. OBJECTIVE To assess alcohol concentrations in the peripheral blood of premature infants and neonatal incubators. DESIGN, SETTING, AND PARTICIPANTS A quality improvement study comparing 2 different populations before and after introduction of ABD practice (ABD-PRAC) was conducted in a neonatal intensive care unit of a single tertiary hospital in Japan. Participants included premature infants who were born before 34 weeks of gestational age and received medical care in neonatal incubators. The study consisted of 3 periods: (1) September 1, 2020, to August 1, 2021 (prospective observation of pre-ABD-PRAC, (2) August 2 to August 22, 2021 (introduction of ABD-PRAC to medical staff and parents in the neonatal intensive care unit), and (3) August 23, 2021, to March 31, 2022 (prospective observation of post-ABD-PRAC). No follow-up studies were initiated. INTERVENTIONS An ABD-PRAC that aimed to reduce alcohol evaporation from ABDs inside neonatal incubators was instituted: (1) place alcohol preps in the incubator just before use and remove them from the incubator as soon as possible and (2) withhold placing hands into the incubators until 60 seconds after using ABDs for disinfection (applied only to family members). MAIN OUTCOMES AND MEASURES Blood alcohol concentration and evaporated alcohol concentrations in neonatal incubators. RESULTS Disinfectant practice was assessed among 28 infants during the pre-ABD-PRAC (17 infants [10 girls]; median gestational age at birth, 29.4 [IQR, 26.3-30.3] weeks) and post-ABD-PRAC (11 infants [3 girls]; median gestational age at birth, 30.0 [IQR, 25.3-32.2] weeks) study periods. The median blood alcohol concentration was 7.0 (IQR, 5.4-9.3) mg/dL pre-ABD-PRAC and 4.2 (IQR, 2.5-7.2) mg/dL post-ABD-PRAC. The median evaporated alcohol concentration inside neonatal incubators during pre-ABD-PRAC during the day was 23.6 (IQR, 15.9-36.5) ppm and, at night, was 13.2 (IQR, 8.9-19.4) ppm; during post-ABD-PRAC, the concentration was 9.4 (IQR, 6.0-16.0) ppm during the day and 5.7 (IQR, 3.6-9.7) ppm at night. The introduction of ABD-PRAC at 22 weeks' corrected gestational age was associated with a lower blood alcohol concentration in premature infants: regression coefficient value, -8.3 (95% CI, -12.0 to -4.7). CONCLUSIONS AND RELEVANCE In this study, alcohol evaporated from ABDs was absorbed by premature infants in neonatal incubators. The findings suggest that introduction of ABD-PRAC was associated with lower alcohol concentrations in neonatal incubators and in the blood of premature infants.
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Affiliation(s)
- Daisuke Hitaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Satoshi Fujiyama
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yukiko Nishihama
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yusuke Hoshino
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Ibaraki, Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yayoi Miyazono
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shoji F. Nakayama
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Bourgeois-Nicolaos N, Raynor A, Shankar-Aguilera S, Schwartz E, Doucet-Populaire F, De Luca D. Breast milk in neonate oral care: oropharyngeal effects in extremely preterm infants. Eur J Pediatr 2023; 182:385-392. [PMID: 36374301 DOI: 10.1007/s00431-022-04692-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
UNLABELLED Ventilator-associated pneumonia (VAP) is a frequent nosocomial infection in neonatal intensive care units (NICU). Extremely preterm infants are at highest risk of developing VAP. Several studies indicate that oral care included in a preventive protocol effectively reduces neonatal VAP incidence. We investigated the effects of oral care with breast milk on oral immune defenses and microbiota in extremely preterm infants. Thirty infants born ≤ 30 weeks gestation hospitalized at our NICU were selected and divided into three groups: oral care with breast milk, formula, or sterile water. Effects on oral immune defenses in vivo were studied using ELISA to measure lactoferrin (LF) and secretory immunoglobulin A (sIgA) in pharyngeal aspirates before and after oral care. Different LF concentrations were tested in vitro to assess their effects on loads of selected bacterial species by culture. Effects on selected bacteria potentially responsible for VAP in vivo were studied by real-time PCR detection in pharyngeal aspirates before and after oral care. Oral care with breast milk significantly increases LF concentrations to 69.8 × 103 ng/ml (p = 0.012) and sIgA to 36.8 × 103 ng/ml (p = 0.017) in vivo. These LF concentrations considerably reduce loads of E. coli, S. epidermidis, S. aureus, and P. aeruginosa, in vitro. However, contrary to our expectation, no effect on colonization of bacteria most commonly responsible for VAP was found in vivo. CONCLUSION In extremely preterm infants, oral care with breast milk increases local immune defense markers (LF, sIgA), which combat bacterial infections. Further clinical trials should be conducted to evaluate their effects on VAP prevention in neonates. WHAT IS KNOWN • The population at higher risk to develop VAP are preterm infants. • Several studies indicate oral care within a preventive bundle is effective in reducing neonatal VAP incidence. WHAT IS NEW • In extremely premature infants, oral care with breast milk causes a significant increase in local immune defences in terms of lactoferrin (LF) and secretory immunoglobulin A (sIgA). • LF concentrations obtained after oral care with breast milk decreased loads of bacteria most commonly responsible for VAP in premature infants under experimental in-vitro.
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Affiliation(s)
- Nadège Bourgeois-Nicolaos
- Department of Bacteriology-Hygiene, APHP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France. .,Institute for Integrative Biology of the Cell, Université Paris-Saclay, CEA, CNRS, I2BC, Gif-Sur-Yvette, France.
| | - Alexandre Raynor
- Department of Bacteriology-Hygiene, APHP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Shivani Shankar-Aguilera
- Department of Neonatal Intensive Care, Université Paris -Saclay, Hôpital Antoine Béclère, Clamart, AP, France
| | - Eden Schwartz
- Department of Bacteriology-Hygiene, APHP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Florence Doucet-Populaire
- Department of Bacteriology-Hygiene, APHP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France.,Institute for Integrative Biology of the Cell, Université Paris-Saclay, CEA, CNRS, I2BC, Gif-Sur-Yvette, France
| | - Daniele De Luca
- Department of Neonatal Intensive Care, Université Paris -Saclay, Hôpital Antoine Béclère, Clamart, AP, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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8
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Abstract
Neonatal late-onset sepsis (LOS) continues to threaten morbidity and mortality in the NICU and poses ongoing diagnostic and therapeutic challenges. Early recognition of clinical signs, rapid evaluation, and prompt initiation of treatment are critical to prevent life-threatening deterioration. Preterm infants-born at ever-decreasing gestational ages-are at particularly high risk for life-long morbidities and death. This changing NICU population necessitates continual reassessments of diagnostic and preventive measures and evidence-based treatment for LOS. The clinical presentation of LOS is varied and nonspecific. Despite ongoing research, reliable, specific laboratory biomarkers facilitating early diagnosis are lacking. These limitations drive an ongoing practice of liberal initiation of empiric antibiotics among infants with suspected LOS. Subsequent promotion of multidrug-resistant microorganisms threatens the future of antimicrobial therapy and puts preterm and chronically ill infants at even higher risk of nosocomial infection. Efforts to identify adjunctive therapies counteracting sepsis-driven hyperinflammation and sepsis-related functional immunosuppression are ongoing. However, most approaches have either failed to improve LOS prognosis or are not yet ready for clinical application. This article provides an overview of the epidemiology, risk factors, diagnostic tools, and treatment options of LOS in the context of increasing numbers of extremely preterm infants. It addresses the question of whether LOS could be identified earlier and more precisely to allow for earlier and more targeted therapy and discusses rational approaches to antibiotic therapy to avoid overuse. Finally, this review elucidates the necessity of long-term follow-up of infants with a history of LOS.
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Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kirsten Glaser
- Division of Neonatology, Department of Women’s and Children’s Health, University of Leipzig Medical Center, Leipzig, Germany
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Zhou J, Mei L, Chen S. Effect of chlorhexidine cleansing on healthcare-associated infections in neonates: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:398-407. [PMID: 34949635 DOI: 10.1136/archdischild-2021-322429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) have a significant impact on neonatal morbidity, mortality and long-term prognosis, which have a high incidence in neonates. Many studies have shown that chlorhexidine cleansing is effective in reducing HAIs in adults, but the effect of chlorhexidine cleansing on HAIs in neonates remains controversial. AIM The purpose of this study was to conduct a systematic review and meta-analysis of the effect of chlorhexidine cleansing on HAIs in neonates. The protocol of this review has been registered with the PROSPERO international prospective register of systematic reviews. METHODS A systematic literature search was performed on five medical literature databases, namely MEDLINE, Web of Science, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL), published up until 3 March 2021. In the end, six studies were eligible for inclusion, including four randomised controlled trials and two quasi-experimental studies. Version 2 of the Cochrane tool for assessing risk of bias in randomised trials and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies were used for quality assessment. Pooled risk ratios (RRs) and their associated 95% CIs were calculated using the fixed effects model (I2 <50%) or the random effects model (I2 ≥50%). FINDINGS AND CONCLUSIONS The results of the meta-analysis revealed that chlorhexidine cleansing had no significant effect on neonatal sepsis (RR: 0.49, 95% CI 0.18 to 1.38, p=0.18, I2=0%), but significantly reduced neonatal skin bacterial colonisation (RR: 0.61, 95% CI 0.42 to 0.90, p=0.01, I2=50%). In addition, this systematic review showed that chlorhexidine cleansing could significantly reduce central line-associated bloodstream infection in neonates based on large-sample studies. However, more studies are needed to determine the optimal concentration and frequency of chlorhexidine cleansing. PROSPERO registration number CRD42021243858.
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Affiliation(s)
- Jinyan Zhou
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People's Republic of China
| | - Lingli Mei
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People's Republic of China
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People's Republic of China
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Jain A, Deshpande P, Yoon EW, Lee KS, McGeer A, Shah V. 2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial. J Perinatol 2022; 42:636-641. [PMID: 35184146 DOI: 10.1038/s41372-022-01337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare 2% aqueous chlorhexidine gluconate (AQC) vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol (ALC) for pre-venipuncture skin antisepsis in very-low-birth-weight neonates (VLBW, birth-weight <1500 grams). STUDY DESIGN Double-blind, non-inferiority trial randomized 199 VLBW neonates, age 2-28 days, to receive pre-venipuncture skin preparation using single application of swabstick impregnated with AQC (n = 99) or ALC (n = 100). Skin clearance rate (percentage post-cleansing skin swabs with <15 bacterial colony forming units) with a 10% non-inferiority margin for AQC was primary outcome. Absolute and relative CFU reduction and adverse skin reactions were compared. RESULTS AQC's clearance was non-inferior to ALC (91% vs. 88%; 95% CI -6.6%, +12.4%). Median (interquartile range) absolute [61 (16, 110) vs. 63 (18, 100); p = 0.65] and relative [100% (97%, 100%) vs. 100% (99.7%, 100%); p = 0.20] CFU reductions were similar. Neither group experienced any adverse reactions. CONCLUSION AQC may provide non-inferior skin disinfection to ALC in VLBW neonates. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01270776.
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Affiliation(s)
- Amish Jain
- Department of Paediatrics, University of Toronto, Toronto, Canada.
| | - Poorva Deshpande
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Eugene W Yoon
- Maternal and Infant Care Research Center (MiCare), University of Toronto, Toronto, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Allison McGeer
- Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Vibhuti Shah
- Department of Paediatrics, University of Toronto, Toronto, Canada
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11
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Sethi DK, Felgate H, Diaz M, Faust K, Kiy C, Clarke P, Härtel C, Rupp J, Webber MA. Chlorhexidine gluconate usage is associated with antiseptic tolerance in staphylococci from the neonatal intensive care unit. JAC Antimicrob Resist 2021; 3:dlab173. [PMID: 34806010 PMCID: PMC8599896 DOI: 10.1093/jacamr/dlab173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022] Open
Abstract
Background Intravascular catheters are essential for care in Neonatal Intensive Care Units (NICUs) but predispose infants to catheter-associated infections including late-onset sepsis, commonly caused by CoNS. Antiseptics are applied to prevent infection with chlorhexidine (CHG) and octenidine (OCT) the most common agents used. Objectives To investigate the association between antiseptic use and bacterial susceptibility. Methods CoNS isolates were collected from two NICUs with differing antiseptic regimens: Norwich, UK (using CHG) and Lubeck, Germany (using OCT). CoNS were isolated from different body sites of babies upon admission, and weekly thereafter. Antiseptic susceptibility testing was performed, and a selection underwent genome sequencing. Results A total of 1274 isolates were collected. UK isolates (n = 863) were significantly less susceptible than German isolates (n = 411) to both CHG (mean MIC: 20.1 mg/L versus 8.9 mg/L) and OCT (mean MIC: 2.3 mg/L versus 1.6 mg/L). UK isolates taken on admission were more susceptible to CHG than subsequent isolates. No cross-resistance between the agents was seen. Genome sequencing of 122 CoNS showed the most common species to be Staphylococcus epidermidis and Staphylococcus haemolyticus and phylogenetic analysis suggested antiseptic tolerance evolved multiple times in independent lineages. There was no evidence of dominant antiseptic tolerant clones and carriage of genes previously implicated in antimicrobial susceptibility (qac, smr, norA/B), did not correlate with CHG or OCT susceptibility. Conclusions Long-term CHG use may select for CHG and OCT tolerance in CoNS. This highlights the different potential for separate antiseptic regimens to select for resistance development. This could be an important factor in developing future infection control policies.
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Affiliation(s)
- Dheeraj K Sethi
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK.,Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Heather Felgate
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
| | - Maria Diaz
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
| | - Kirstin Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Cemsid Kiy
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK.,Neonatal Unit, Norfolk and Norwich University Hospital (NNUH), Norwich NR4 7UY, UK
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Mark A Webber
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK.,Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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12
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Tran AQ, Topilow N, Rong A, Persad PJ, Lee MC, Lee JH, Anagnostopoulos AG, Lee WW. Comparison of Skin Antiseptic Agents and the Role of 0.01% Hypochlorous Acid. Aesthet Surg J 2021; 41:1170-1175. [PMID: 33247899 PMCID: PMC8438591 DOI: 10.1093/asj/sjaa322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Hypochlorous acid (HA) has both anti-microbial and wound-healing properties with a growing role for utilization in pre-procedural care on the face. OBJECTIVES The authors sought to compare the antiseptic property of 0.01% HA solution, 5% povidone iodine (PI), 4% chlorhexidine gluconate (CHG), and 70% isopropyl alcohol (IPA) antiseptic on facial skin. METHODS This was a prospective single-center clinical trial. RESULTS A total of 21 participants were recruited. Bacterial growth was seen in CHG (10%), IPA (71%), PI (81%), and HA (95%) of specimens (P < 0.001). CHG had less growth compared with HA (P = <0.001), IPA (P = <0.001), and PI (P = <0.001). No difference in bacterial growth was noted between HA and IPA (P = 0.063) or HA and PI (P = 0.25). Significant differences in mono-microbial and poly-microbial growth were seen between HA and IPA (P = 0.046) and HA and CHG (P = <0.001). Staphylococcus epidermidis grew less frequently in CHG (10%), followed by IPA (29%), PI (71%), and HA (71%). Staphylococcus capitis grew less frequently in CHG (0%), followed by PI (14%), HA (24%), and IPA (29%). CONCLUSIONS CHG reduced the bacterial growth compared with HA, PI, and IPA. However, HA, PI, and IPA had insignificant differences in bactericidal effects. Our study provides a supporting role of HA to be considered as an antiseptic. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Ann Q Tran
- Department of Ophthalmology, Oculoplastic and Reconstructive Surgery, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
| | - Nicole Topilow
- Department of Ophthalmology, Oculoplastic and Reconstructive Surgery, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
| | - Andrew Rong
- Department of Ophthalmology, Oculoplastic and Reconstructive Surgery, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
| | - Patrice J Persad
- Department of Statistics, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
| | | | - James H Lee
- Westminster High School, Palmetto Bay, FL, USA
| | - Apostolos G Anagnostopoulos
- Department of Ophthalmology, Oculoplastic and Reconstructive Surgery, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
| | - Wendy W Lee
- Department of Ophthalmology, Oculoplastic and Reconstructive Surgery, University of Miami Bascom Palmer Eye Institute, Miami, FL, USA
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13
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[Challenges in neonatal dermatology : An introduction]. Hautarzt 2021; 72:185-193. [PMID: 33651115 DOI: 10.1007/s00105-021-04764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
In order to support dermatologists' interest for the fascinating area of neonatal dermatology, we provide (1) an introduction to the specifics of skin barrier in premature and full-term neonates as well as their clinical implications and (2) an example of age-dependent differential diagnoses and approach to a facial vascular stain in a neonate.
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Muhd Helmi MA, Lai NM, Van Rostenberghe H, Ayub I, Mading E. Antiseptic solutions for skin preparation during central catheter insertion in neonates. Hippokratia 2021. [DOI: 10.1002/14651858.cd013841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Muhd A Muhd Helmi
- Department of Paediatrics; International Islamic University Malaysia; Kuantan Malaysia
| | - Nai Ming Lai
- School of Medicine; Taylor's University; Subang Jaya Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences; Universiti Sains Malaysia; Kubang Kerian Malaysia
| | - Izzudeen Ayub
- Department of Paediatrics; Universiti Sultan Zainal Abidin; Kuala Terengganu Malaysia
| | - Emie Mading
- Faculty of Medicine and Health Sciences; University Malaysia Sabah (UMS); Sabah Malaysia
- Department of Paediatrics; School of Medical Sciences, Universiti Sains Malaysia; Kubang Kerian Malaysia
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A 1-year survey of catheter-related infections in a pediatric university hospital: A prospective study. Arch Pediatr 2019; 27:79-86. [PMID: 31791827 DOI: 10.1016/j.arcped.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Central venous catheters (CVCs) provide a great comfort for hospitalized children. However, CVCs increase the risk of severe infection. As there are few data regarding pediatric epidemiology of catheter-related infections (CRIs), the main objective of this study was to measure the incidence rate of CRIs in our pediatric university hospital. We also sought to characterize the CRIs and to identify risk factors. MATERIALS AND METHODS We conducted an epidemiological prospective monocentric study including all CVCs, except Port-a-Caths and arterial catheters, inserted in children from birth to 18 years of age between April 2015 and March 2016 in the pediatric University Hospital of Nantes. Our main focus was the incidence rate of CRIs, defined according to French guidelines, while distinguishing between bloodstream infections (CRBIs) and non-bloodstream infections (CRIWBs). The incidence rate was also described for each pediatric ward. We analyzed the association between infection and potential risk factors using univariate and multivariate analysis by Cox regression. RESULTS We included 793 CVCs with 60 CRBIs and four CRIWBs. The incidence rate was 4.6/1000 catheter-days, with the highest incidence rate occurring in the neonatal intensive care unit (13.7/1000 catheter-days). Coagulase-negative staphylococci were responsible for 77.5% of the CRIs. Factors independently associated with a higher risk of infection in neonates were invasive ventilation and low gestational age. CONCLUSIONS The incidence of CRIs in children hospitalized in our institution appears to be higher than the typical rate of CRIs reported in the literature. This was particularly true for neonates. These results should lead us to reinforce preventive measures and antibiotic stewardship but they also raise the difficulty of diagnosing with certainty CRIs in neonates.
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16
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Clarke P, Craig JV, Wain J, Tremlett C, Linsell L, Bowler U, Juszczak E, Heath PT. Safety and efficacy of 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheter insertion in preterm neonates: the ARCTIC randomised-controlled feasibility trial protocol. BMJ Open 2019; 9:e028022. [PMID: 30782955 PMCID: PMC6411256 DOI: 10.1136/bmjopen-2018-028022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Catheter-related sepsis is one of the most dangerous complications of neonatal intensive care and is associated with significant morbidity and mortality. Use of catheter-care 'bundles' has reduced the incidence of catheter-related sepsis, although individual components have not been well studied. Better evidence is needed to guide selection of the most appropriate antiseptic solution for skin disinfection in preterm neonates. This study will inform the feasibility and design of the first randomised controlled trial to examine the safety and efficacy of alcohol-based versus aqueous-based chlorhexidine antiseptic formulations for skin disinfection prior to percutaneous central venous catheterisation in preterm neonates. The antiseptics to be compared are 2% chlorhexidine gluconate (CHG) aqueous and 2% CHG in 70% isopropyl alcohol. METHODS AND ANALYSIS The Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) is a two-centre randomised-controlled feasibility trial. At least 100 preterm infants born at <34 weeks' gestation and due to undergo percutaneous insertion of a central venous catheter will be randomly allocated to receive prior skin disinfection with one of the two antiseptic solutions. Outcomes include: i) recruitment and retention rates; ii) completeness of data collection; iii) numbers of enrolled infants meeting case definitions for definite catheter-related sepsis, catheter-associated sepsis and catheter colonisation and iv) safety outcomes of skin morbidity scores recorded daily from catheter insertion until 48 hours post removal. The key feasibility metrics will be reported as proportions with 95% CIs. Estimated prevalence of catheter colonisation will allow calculation of sample size for the large-scale trial. The data will inform whether it will be feasible to progress to a large-scale trial. ETHICS AND DISSEMINATION ARCTIC has been approved by the National Health Service Health Research Authority National Research Ethics Service Committee East of England (Cambridge South) (IRAS ID 163868), was adopted onto the National Institute of Health Research Clinical Research Network portfolio (CPMS ID 19899) and is registered with an International Standard Randomised Control Trials Number (ISRCTN: 82571474; Pre-results) and European Clinical Trials Database number 2015-000874-36. Dissemination plans include presentations at scientific conferences, scientific publications and sharing of the findings with parents via the support of Bliss baby charity. TRIAL REGISTRATION NUMBER ISRCTN82571474; Pre-results.
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Affiliation(s)
- Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jean V Craig
- Research Design Service, Norwich Medical School, University of East Anglia, Norwich, UK
| | - John Wain
- Norwich Medical School, University of East Anglia, Norwich, UK
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Catherine Tremlett
- Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ursula Bowler
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Infection and Immunity, St George’s University of London, London, UK
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Johnson J, Suwantarat N, Colantuoni E, Ross TL, Aucott SW, Carroll KC, Milstone AM. The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. J Perinatol 2019; 39:63-71. [PMID: 30237474 PMCID: PMC6298801 DOI: 10.1038/s41372-018-0231-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the impact of chlorhexidine gluconate (CHG) bathing on skin bacterial burden in neonates. STUDY DESIGN In this prospective observational study, arm and groin skin bacterial growth was measured in 40 CHG-exposed and nonexposed neonates admitted to the NICU. Exposed neonates received 2% CHG baths per protocol for central line-associated bloodstream infection (CLABSI) prevention or Staphylococcus aureus decolonization. RESULTS Forty neonates were enrolled, 18 of whom were CHG-exposed. Mean baseline Gram-positive (GP) bacterial burden was 2.19 log CFU/ml on the arm and 1.81 log CFU/ml on the groin. Bacterial burden decreased after the first bath, but returned to baseline by 72 h. Residual skin CHG concentration declined over time, with a corresponding increase in GP bacterial burden. CONCLUSIONS CHG bathing reduces skin bacterial burden, but burden returns to baseline after 72 h. Twice weekly CHG bathing may be inadequate to suppress skin bacterial growth in hospitalized neonates.
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Affiliation(s)
- Julia Johnson
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Nuntra Suwantarat
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Maryland, United States of America
| | - Tracy L. Ross
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Susan W. Aucott
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Karen C. Carroll
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Maryland, United States of America
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Schmid S, Geffers C, Wagenpfeil G, Simon A. Preventive bundles to reduce catheter-associated bloodstream infections in neonatal intensive care. GMS HYGIENE AND INFECTION CONTROL 2018; 13:Doc10. [PMID: 30588416 PMCID: PMC6289088 DOI: 10.3205/dgkh000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This systematic survey includes a total of 27 studies published between 2002 and 2016 on the benefit of preventive bundles for the prevention of central-line associated bloodstream infections (CLABSI) in neonatal intensive care. These studies are mainly cohort studies or studies analyzing an interrupted time series before and after intervention. The studies showed heterogeneity in terms of endpoint definitions (CLABSI), details of the implemented measures, and evidence of a publication bias favoring the use of of preventive bundles. The cumulative analysis showed a statistically and clinically significant benefit of preventive bundles to avoid CLABSI in neonatal intensive care.
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Affiliation(s)
- Sarah Schmid
- University Hospital of the Saarland, Children's Hospital, Pediatric Oncology and Hematology, Homburg, Germany
| | - Christine Geffers
- German National Reference Center for Surveillance of Nosocomial Infections, Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometrics, Epidemiology and Medical Computer Sciences, University Hospital of the Saarland, Homburg, Germany
| | - Arne Simon
- University Hospital of the Saarland, Children's Hospital, Pediatric Oncology and Hematology, Homburg, Germany
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20
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Fraser C, Harron K, Dalton L, Gilbert R, Oddie SJ. Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales. PLoS One 2018; 13:e0204894. [PMID: 30383769 PMCID: PMC6211675 DOI: 10.1371/journal.pone.0204894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background There is uncertainty about the variation in infection prevention practices for central venous catheters (CVC) in neonatal units (NNUs) and how practices relate to national guidance. Aim To evaluate evidence supporting infection prevention practices for CVCs recommended in national guidelines and to compare with reported practices for peripherally inserted central catheters (PICC), a type of CVC widely used in NNUs. Design We searched national guidelines for neonates and children to identify infection prevention practices for CVCs and conducted an overview of studies to determine the quality of evidence underpinning recommendations. We surveyed 134 NNUs in England and Wales to ascertain reported practice. Results We found low quality evidence supporting CVC care bundles and use of 2% alcoholic chlorhexidine to decontaminate catheter ports and skin before insertion. Moderate quality evidence supported recommendations against routinely replacing CVCs and against chlorhexidine-impregnated dressings. 90% (44/49) of NICUs and 40% (34/85) of LNUs responded. 66% (48/73) of NNUs reported using CVC care bundles for insertion; 62% (45/73) used bundles for maintenance. 63% (32/51) of those using bundles reported monitoring adherence. 85% (61/72) of NNUs did not routinely replace PICCs and 89% (63/71) did not use chlorhexidine-impregnated dressings. Antiseptic use varied with alcoholic 2% chlorhexidine used for skin preparation in 33% (23/71) of NNUs and for catheter ports in 52% (37/71). Conclusions Lack of consistency across NNUs in antiseptic use and low rates of reported CVC care bundle use may reflect the low quality of evidence of the effectiveness and safety of these interventions in NNUs. Clinical trials are needed to quantify benefits and harms of infection prevention practices in NNUs.
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Affiliation(s)
- Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Laura Dalton
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sam J. Oddie
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom
- Centre for reviews and dissemination, University of York, York, United Kingdom
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Ciccia M, Chakrokh R, Molinazzi D, Zanni A, Farruggia P, Sandri F. Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience. Am J Infect Control 2018; 46:169-172. [PMID: 28967509 DOI: 10.1016/j.ajic.2017.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
AIM The study reports a 2-year single-center experience of the practice of skin antisepsis using a 0.05% sodium hypochlorite solution before central venous catheter placement in neonates. METHODS Eligible subjects included any hospitalized neonate who needed a central line for at least 48 hours. Infants were excluded if they had a generalized or localized skin disorder. An ad hoc Excel (Microsoft Corp, Redmond, WA) file was used to record the data from each patient. The catheter sites were monitored daily for the presence of contact dermatitis. Central line-associated bloodstream infection was diagnosed according to Centers for Disease Control and Prevention definition. RESULTS One hundred five infants underwent central venous catheter placement and were enrolled. A total of 198 central lines were inserted. The median gestational age was 31 weeks (range, 23-41 weeks) and median birth weight was 1,420 g (range, 500-5,170 g). There were no signs of 0.05% sodium hypochlorite-related skin toxicity in any infant. Of 198 catheters (1,652 catheter-days) prospectively studied, 9 were associated with bloodstream infections (5.4 per 1,000 catheter-days). CONCLUSION During the observation period, no local adverse effects were observed suggesting that 0.05% sodium hypochlorite may be a safe choice in this context.
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Affiliation(s)
- Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy.
| | - Roksana Chakrokh
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| | - Dario Molinazzi
- Management Control and Information Flow Unit, Local Health Authority, Bologna, Italy
| | - Angela Zanni
- Hospital Infection Control Unit, Local Health Authority, Bologna, Italy
| | | | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
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22
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Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature. J Perinat Neonatal Nurs 2018; 32:341-350. [PMID: 29782437 DOI: 10.1097/jpn.0000000000000334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Early premature infants are subjected to many invasive procedures in neonatal intensive care units, and effective skin antisepsis is an essential step in caring for these vulnerable patients. Nevertheless, preterm infants have an anatomically and physiologically immature skin and preserving their skin integrity is essential to avoid the risk of local and systemic complications. Skin particularities of newborns reduce the list of available antiseptics in neonatology. Chlorhexidine gluconate (CHG) has excellent antiseptic properties and its antimicrobial efficacy cannot be understated, but there is great concern about its use for premature infants, referring to the risk of development skin injuries, such as skin erythema, burns, and blisters. Current guidelines do not recommend the use of CHG as antiseptic in the neonatal population, but despite the lack of safety data in premature infants, CHG is commonly used worldwide for off-label indications in neonatal intensive care units. A clinical case of an infant born at 26 weeks of gestation who sustained a CHG-related chemical burn after skin antisepsis was reported. A review of the literature was undertaken to evaluate the skin safety of CHG in infants born less than 32 weeks of gestation, to summarize clinical practice' recommendations, and to discuss the wound treatment options available.
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23
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Song JE, Kwak YG, Um TH, Cho CR, Kim S, Park IS, Hwang JH, Kim N, Oh GB. Outbreak of Burkholderia cepacia pseudobacteraemia caused by intrinsically contaminated commercial 0.5% chlorhexidine solution in neonatal intensive care units. J Hosp Infect 2017; 98:295-299. [PMID: 28935523 DOI: 10.1016/j.jhin.2017.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Burkholderia cepacia is intrinsically resistant to certain antiseptics. The authors noted a sudden increase in the frequency of isolation of B. cepacia from blood cultures in a neonatal intensive care unit (NICU) of a university-affiliated hospital. AIM To identify the source and intervene in the ongoing infections. METHODS The cases were defined as patients with positive blood cultures for B. cepacia in an NICU between November 2014 and January 2015. Medical records were reviewed and NICU healthcare workers were interviewed. Samples of suspected antiseptics, blood culture bottles, cotton balls, gauze and a needle used in the NICU were analysed microbiologically. FINDINGS During the outbreak period, B. cepacia was identified in 25 blood cultures obtained from 21 patients. The clinical features of the patients were suggestive of pseudobacteraemia. Regarding environmental samples, B. cepacia was cultured from 0.5% chlorhexidine gluconate (CHG) solution products that had been used as a skin antiseptic during blood drawing in the NICU. The clinical B. cepacia isolate and two strains obtained from 0.5% CHG exhibited identical pulsed-field gel electrophoresis patterns. After the CHG products were withdrawn, the outbreak was resolved. CONCLUSIONS The pseudobacteraemia cases were caused by contaminated 0.5% CHG produced by a single manufacturer. Stricter government regulation is needed to prevent contamination of disinfectants during manufacturing. In addition, microbial contamination of antiseptics and disinfectants should be suspected when a B. cepacia outbreak occurs in hospitalized patients.
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Affiliation(s)
- J E Song
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
| | - T H Um
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - C R Cho
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - S Kim
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - I S Park
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - J H Hwang
- Department of Paediatrics, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - N Kim
- Department of Paediatrics, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - G-B Oh
- Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
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24
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Paternoster M, Niola M, Graziano V. Avoiding Chlorhexidine Burns in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2017; 46:267-271. [DOI: 10.1016/j.jogn.2016.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 12/22/2022] Open
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25
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Williams FLR, Watson J, Day C, Soe A, Somisetty SK, Jackson L, Velten E, Boelen A. Thyroid dysfunction in preterm neonates exposed to iodine. J Perinat Med 2017; 45:135-143. [PMID: 27564693 DOI: 10.1515/jpm-2016-0141] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Infants <32 weeks' gestation should not be exposed to topical iodine and its avoidance is recommended during pregnancy and breast feeding. Exposure to contrast media and topical iodine is frequently used in many preterm neonates. AIM To determine whether thyrotropin levels in preterm infants are affected by exposure to intrapartum/neonatal topical iodine and/or the use of iodinated contrast media. DESIGN Infants <32 weeks' gestation were recruited. Maternal and neonatal exposures to iodinated contrast media and topical iodine were recorded; levels of thyrotropin and thyroxine were measured from blood-spot cards on postnatal days 7, 14, 28 and the equivalent of 36 weeks' gestation. RESULTS One hundred and twenty-five infants were exposed to topical iodine/contrast media and 48 infants were unexposed. No infants were treated for hypothyroidism; three infants (exposed group) had transient hyperthyrotropinaemia. Mean thyrotropin levels were significantly higher on postnatal days 7, 14 and 28 in infants exposed to topical iodine prior to caesarean section compared to unexposed infants, a relationship which persisted after adjustment. CONCLUSIONS In the context of this study, neonatal thyroid dysfunction was seen following exposure to iodine via caesarean section but not via exposure to contrast media.
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26
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Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm. Adv Neonatal Care 2016; 16 Suppl 5S:S26-S32. [PMID: 27676111 DOI: 10.1097/anc.0000000000000335] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. PURPOSE We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. METHOD Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. FINDINGS Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. IMPLICATIONS FOR PRACTICE Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. IMPLICATIONS FOR RESEARCH Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.
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27
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O'Connor C, Philip RK, Powell J, Slevin B, Quinn C, Power L, O'Connell NH, Dunne CP. Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care. J Hosp Infect 2016; 93:105-7. [PMID: 26944902 DOI: 10.1016/j.jhin.2016.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher's exact test: P = 0.0259). No dermatological sequelae were observed. The improvement has been sustained.
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Affiliation(s)
- C O'Connor
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - R K Philip
- Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Ireland
| | - B Slevin
- Infection Prevention & Control Team, University Hospital Limerick, Ireland
| | - C Quinn
- Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland
| | - L Power
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - C P Dunne
- Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland.
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28
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Hugill K. Vascular access in neonatal care settings: selecting the appropriate device. ACTA ACUST UNITED AC 2016; 25:171-6. [DOI: 10.12968/bjon.2016.25.3.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kevin Hugill
- Director of Nursing, Hamad Medical Corporation, Qatar
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29
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30
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Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100:F257-63. [PMID: 25425653 PMCID: PMC4413803 DOI: 10.1136/archdischild-2014-306213] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/28/2023]
Abstract
The incidence of neonatal late-onset sepsis (LOS) is inversely related to the degree of maturity and varies geographically from 0.61% to 14.2% among hospitalised newborns. Epidemiological data on very low birth weight infants shows that the predominant pathogens of neonatal LOS are coagulase-negative staphylococci, followed by Gram-negative bacilli and fungi. Due to the difficulties in a prompt diagnosis of LOS and LOS-associated high risk of mortality and long-term neurodevelopmental sequelae, empirical antibiotic treatment is initiated on suspicion of LOS. However, empirical therapy is often inappropriately used with unnecessary broad-spectrum antibiotics and a prolonged duration of treatment. The increasing number of multidrug-resistant Gram-negative micro-organisms in neonatal intensive care units (NICU) worldwide is a serious concern, which requires thorough and efficient surveillance strategies and appropriate treatment regimens. Immunological strategies for preventing neonatal LOS are not supported by current evidence, and approaches, such as a strict hygiene protocol and the minimisation of invasive procedures in NICUs represent the cornerstone to reduce the burden of neonatal LOS.
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Affiliation(s)
- Ying Dong
- Department of Paediatrics, Children's Hospital of Fudan University, Shanghai, China
| | - Christian P Speer
- University Children's Hospital, University of Würzburg, Würzburg, Germany
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31
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Ponnusamy V, Perperoglou A, Venkatesh V, Curley A, Brown N, Tremlett C, Clarke P. Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter-related sepsis. Acta Paediatr 2014; 103:1233-8. [PMID: 25164200 DOI: 10.1111/apa.12779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/12/2014] [Accepted: 08/14/2014] [Indexed: 12/01/2022]
Abstract
AIM The commonest mode of catheter colonisation is via the extraluminal route with skin bacteria. Catheter-related sepsis causes significant mortality and morbidity in neonates. Our aim was to study the relationships between culture-positive catheter exit site skin swabs, percutaneous central venous catheter segments and blood to determine the magnitude of associations between exit site skin colonisation, catheter colonisation and catheter-related sepsis. METHODS In a prospective study, an exit site skin swab and three formerly in vivo catheter segments (proximal, middle and tip) were taken for culture at catheter removal. In those neonates who were clinically unwell at catheter removal, a peripheral blood culture was also collected. Univariate and multivariate analyses were used to study associations. RESULTS Skin swabs were culture positive in 39 (21%) of 187 catheter removals. With a culture-positive skin swab, the risk of associated catheter colonisation was nearly eight times higher (OR: 7.84, 95% CI: 3.59-17.15) and the risk of definite catheter-related sepsis with the same organism was nearly 10 times higher (OR 9.86, 95% CI: 3.13-31.00). CONCLUSION Culture-positive skin swabs from the catheter exit site were strongly associated with catheter colonisation and with definite catheter-related sepsis with the same organism. These data provide further evidence supporting catheter colonisation via the extraluminal route and highlight the importance of optimising skin disinfection before catheter insertion.
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Affiliation(s)
- Vennila Ponnusamy
- Neonatal Unit; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - Aris Perperoglou
- Department of Mathematical Sciences; University of Essex; Colchester UK
| | - Vidheya Venkatesh
- Neonatal Unit; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Anna Curley
- Neonatal Unit; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Nicholas Brown
- Clinical Microbiology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Catherine Tremlett
- Department of Microbiology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - Paul Clarke
- Neonatal Unit; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
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