Risk Factors for Health Care-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

Magnitude of neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Hawassa Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia, 2020

BACKGROUND

Neonatal sepsis is one of the most common causes of disease and death among neonates globally. And it made a great contribution to neonatal admission to intensive care units. To mitigate the ongoing neonatal crisis and accomplish the goal of sustainable development through a decrease in neonatal mortality, information from various regions is needed. Despite the considerable burden of neonatal sepsis in our setting, no prior studies were conducted in the study area. So, this study aimed to assess the magnitude and associated factors of neonatal sepsis among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia.

METHODS

A hospital-based cross-sectional study was carried out among 287 neonates from March 1, 2020, to April 25, 2020. An interviewer-administered structured questionnaire was used to collect the data. The data were cleaned, coded, and entered into Epi Data 3.1 software and exported to Statistical Package for Social Science (SPSS) software version 23.0 for analysis. Binary logistic regression analyses were performed to identify variables having a significant association with neonatal sepsis. A p-value of ≤ 0.05 was considered statistically significant during multivariable logistic regression.

RESULTS

The study found that the magnitude of neonatal sepsis was 56%. The mean age of neonates was 3.2(SD±2.2) days. Around two-fifths (39%) of neonates were in the gestational age of <37 completed weeks. A quarter of mothers(25.8%) were delivered through cesarean section. During labor, 251 (87.5%) mothers had ≤4 digital vaginal examinations. Moreover, the finding revealed that mothers who delivered by cesarean section [AOR = 2.13, 95% CI (1.090-4.163)]. neonates who had been resuscitated at birth [AOR = 4.5, 95% CI (2.083-9.707)], and neonates who had NG tube inserted [AOR = 4.29, 95% CI (2.302-8.004)] were found to be significantly associated with neonatal sepsis.

CONCLUSIONS

The current study shows that neonatal sepsis was prevalent among more than half of the neonates admitted to the NICU. Therefore, designing strategies to enhance the aseptic techniques of professionals in the provision of care and actively and collaboratively working with cluster health facilities is highly recommended.

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018-2023 in Southeastern US

BACKGROUND

The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants.

METHODS

367 preterms born at <32 weeks gestational age (GA) between 2019-2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics.

RESULTS

The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715).

CONCLUSIONS

BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Determinants of late neonatal nosocomial infection: a case-control study in Ceará

OBJECTIVES

To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care.

METHODS

This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant.

RESULTS

Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56-0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30-0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84-35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12-5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26-9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54-7.69); central venous catheters (OR = 10.00; 95%CI: 6.66-16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02-5.12); surgery (OR = 4.00; 95%CI: 2.27-7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83-17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26-2.68); central venous catheters (OR = 2.48; 95%CI: 1.40-4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections.

CONCLUSION

Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

Efficiency of Topical Rifampin on Infection in Open Neural Tube Defects: A randomized controlled trial

Objectives: Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects.Methods: Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis.Results: None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (p = 0.01, p = 0.032, p = 0.032, and p = 0.002, respectively). No local or systemic side effect was observed regarding rifampin use.Conclusion: Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.

Epidemiologic profile of nosocomial infections among paediatric patients in a referral hospital in Hamadan, west of Iran

Healthcare-associated infections (HC-AI) are major health problem with high financial impact. HC-AIs are one of the main causes of morbidity and mortality in paediatric hospitals. This study was performed to determine the epidemiology of HC-AIs in children admitted to medical wards of Besat Hospital in Hamadan, west of Iran. Data on cases of HC-AIs in paediatrics were collected from March 2017 to February 2018 in Besat Hospital. The medical records of eligible cases were extracted from Iranian Nosocomial Infections Surveillance Software. During the study period, a total of 355 HC-AIs in children were detected, 213 (60%) in boys and 214 (60.3%) in the 0-4-year age group. Of these, bloodstream infection was the most frequent infection in both age groups (37.38% in 0-4 years and 34.75% in 5-14 years). Escherichia coli was the common detected microorganism in girls (25.84% in those aged 0-4 years and 24.53% in 5-14 years), whereas Staphylococcus was more prevalent in boys (33.6% in those aged 0-4 years and 29.55% in 5-14 years). HC-AIs were more prevalent in burn, haematology and intensive care unit wards. In Besat Hospital, bloodstream infection and urinary tract infection were the most frequent infections among paediatric patients, and E. coli and Staphylococcus were the commonest detected microorganism in girls and boys respectively. Preventive activities should be targeted to reduce the rate of HC-AIs in wards associated with more contamination.

Antimicrobial resistance and virulence determinants in coagulase-negative staphylococci isolated mainly from preterm neonates

Coagulase-negative staphylococci (CoNS) are the most common isolates from blood culture in neonates resulting in high mortality and morbidity. This study investigated CoNS obtained from blood cultures of neonates for antibiotic resistance and virulence factors, and possible association with inflammatory response (C-reactive protein). A total of 93 CoNS isolates were collected from 76 blood cultures of neonates at the Maternity hospital in Kuwait in a six-month period and investigated for susceptibility to antibiotics, carriage of staphylococcal cassette chromosome mec (SCCmec), and virulence-associated genes. The 93 CoNS isolates consisted of S. epidermidis (76; 81.7%), S. capitis (12; 12.9%), S. hominis (2; 2.1%), S. warneri (2; 2.1%) and S. haemolyticus (1; 1.0%). Eighty-six (92.4%) of the isolates were resistant to cefoxitin (MR-CoNS) while 49 (52.7%) expressed multi-antibiotic resistance. The methicillin-resistant isolates (MR-CoNS) carried SCCmec III, SCCmec IVa and four combinations of SCCmec types including SCCmec types I+IVa (one S. warneri and 25 S. epidermidis isolates), types I+III (one S. epidermidis isolate), types III+IVa (six S. epidermidis isolates) and types I+III+IVa (one S. epidermidis isolate). The most common virulence-related genes were icaC, seb, arc detected in 69.7%, 60.5%, 40.8% of the isolates respectively. Two isolates were positive for tst1. No association between C-reactive protein and antibiotic resistance or virulence factors was established. This study revealed that S. epidermidis carrying different SCCmec genetic elements, was the dominant CoNS species isolated from neonatal blood cultures with 90.3% and 36.6% of the isolates positive for genes for biofilm and ACME production respectively.

Predictors of neonatal sepsis in public referral hospitals, Northwest Ethiopia: A case control study

BACKGROUND

Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia.

METHODS

Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05.

RESULT

Multivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2).

CONCLUSION

Neonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.

Intestinal carriage of antibiotic resistant Acinetobacter baumannii among newborns hospitalized in Moroccan neonatal intensive care unit

This study was conducted in order to assess the acquisition rate of Acinetobacter baumannii by newborn screening, on admission and during the discharge process of neonatal intensive care unit. (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was conducted in the neonatal unit of Hassan II University Hospital of Fez from February 2013 to July 2015. During this period, all consecutive admitted neonates were screened for A. baumannii intestinal carriage, on admission and during the discharge process. Bacteriological and molecular tests were evaluated according to the international standards. This study examines the screening on admission of 455 newborns, 59% of whom were male. The average gestational age and birth weight were 35.2 weeks and 2612.1 g respectively. In total, 277 patients were included in the acquisition study on admission. The prevalence of multi-drug resistant (MDR) A. baumannii strain carriage was 6.5%, while the acquisition rate during the hospital recovery was 13.7%. In this study, 68 MDR A. baumannii isolates were collected. The resistance rates to different antibiotic classes including, Ceftazidime, Gentamycin and Ciprofloxacin varied between 92 and 100%. Moreover, 13% of MDR A. baumannii isolates were carbapenemase producers and 88% harbored blaOXA-23 gene. On admission, three risk factors were significantly associated with A. baumannii colonization: age (OR, 2.803; IC95%, 1.191-6.596; P = 0.01), gender (OR, 0.382; IC95%, 0.158-0.921; P = 0.03) and the delivery birth at the Maternity of University Hospital (MUH), (OR, 0.196; IC95%, 0.071-0.540; P = 0.002). However during hospitalization, the only risk factor associated with acquisition of A. baumannii was the respiratory distress (OR, 2.270; IC95%, 1.055-4.881; P = 0.03). A high intestinal carriage rate of A. baumannii and multiple antibiotic resistance were found in our NICU. Thus, the spread of MDR A. baumannii should be monitored by an active surveillance strategy.

Negative Temperature Differential in Preterm Infants Less Than 29 Weeks Gestational Age: Associations With Infection and Maternal Smoking

BACKGROUND

Hypothermia is related to increased morbidity and mortality in very preterm infants; continuous temperature monitoring is necessary. Thermoregulation is limited in preterm infants.

OBJECTIVES

The purpose of the research was to assess and describe negative temperature differential (NTD) and assess the associations of NTD with infant demographic characteristics, medical history, and clinical events.

METHODS

An exploratory, case study design was used. Abdominal and foot temperature was measured every minute over the first 2 weeks of life in 22 preterm infants at less than 29 weeks gestational age.

RESULTS

All infants experienced NTD. Daily NTD in all infants across all study days ranged from 0 to 70.7%; 2-week mean NTD over all infants ranged from 7.3% to 38.5%. Four infants treated for late onset of infection had a higher NTD than 18 infants without infection (M = 27.8%, SD = 9.52 vs. M = 16.4%, SD = 5.34, p < .05). Although not statistically significant, higher mean percentage of NTD was noted in infants having early onset infection (24.1% vs. 16.4%), African American race (20.0% vs. 15.3%), and/or being born to a mother who smoked during pregnancy (26.6% vs. 16.7%).

DISCUSSION

A larger study is needed to examine associations between NTD and race, maternal smoking history, and infection. NTD might be used as a biomarker to guide acute clinical care and identify infants at risk for acute and chronic morbidity.