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Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality

Evelien Verstraete (UGent) , Jerina Boelens (UGent) , Chris De Coen, Geert Claeys (UGent) , Dirk Vogelaers (UGent) , Piet Vanhaesebrouck (UGent) and Stijn Blot (UGent)
Author
Organization
Abstract
Objective. To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011). Design. Historical cohort study. Setting. Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital. Patients. Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD). Methods. A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis. Results. In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001). Conclusions. An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.
Keywords
RISK-FACTORS, BIRTH-WEIGHT INFANTS, NOSOCOMIAL-INFECTIONS, SURVEILLANCE-SYSTEM, RESEARCH NETWORK, EXPERIENCE, SEPSIS, DEFINITION, PREVENTION, 8-YEAR

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MLA
Verstraete, Evelien, Jerina Boelens, Chris De Coen, et al. “Healthcare-associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-year Period (1992-2011) : Trends in Incidence, Pathogens, and Mortality.” INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 35.5 (2014): 511–518. Print.
APA
Verstraete, Evelien, Boelens, J., De Coen, C., Claeys, G., Vogelaers, D., Vanhaesebrouck, P., & Blot, S. (2014). Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 35(5), 511–518.
Chicago author-date
Verstraete, Evelien, Jerina Boelens, Chris De Coen, Geert Claeys, Dirk Vogelaers, Piet Vanhaesebrouck, and Stijn Blot. 2014. “Healthcare-associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-year Period (1992-2011) : Trends in Incidence, Pathogens, and Mortality.” Infection Control and Hospital Epidemiology 35 (5): 511–518.
Chicago author-date (all authors)
Verstraete, Evelien, Jerina Boelens, Chris De Coen, Geert Claeys, Dirk Vogelaers, Piet Vanhaesebrouck, and Stijn Blot. 2014. “Healthcare-associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-year Period (1992-2011) : Trends in Incidence, Pathogens, and Mortality.” Infection Control and Hospital Epidemiology 35 (5): 511–518.
Vancouver
1.
Verstraete E, Boelens J, De Coen C, Claeys G, Vogelaers D, Vanhaesebrouck P, et al. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY. 2014;35(5):511–8.
IEEE
[1]
E. Verstraete et al., “Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality,” INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, vol. 35, no. 5, pp. 511–518, 2014.
@article{4223435,
  abstract     = {Objective. To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011).
Design. Historical cohort study. 
Setting. Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital.
Patients. Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD).
Methods. A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis.
Results. In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001).
Conclusions. An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.},
  author       = {Verstraete, Evelien and Boelens, Jerina and De Coen, Chris and Claeys, Geert and Vogelaers, Dirk and Vanhaesebrouck, Piet and Blot, Stijn},
  issn         = {0899-823X},
  journal      = {INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY},
  keywords     = {RISK-FACTORS,BIRTH-WEIGHT INFANTS,NOSOCOMIAL-INFECTIONS,SURVEILLANCE-SYSTEM,RESEARCH NETWORK,EXPERIENCE,SEPSIS,DEFINITION,PREVENTION,8-YEAR},
  language     = {eng},
  number       = {5},
  pages        = {511--518},
  title        = {Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality},
  url          = {http://dx.doi.org/10.1086/675836},
  volume       = {35},
  year         = {2014},
}

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