Abstract:
Background: The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives.
Aim: To describe the nation-wide epidemiology of central-line associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs).
Methods: Data from 2,935 neonates born <32 weeks' gestation and/or with a birth weight <1,500 grams admitted to all 9 Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1,000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multivariable logistic mixed-modelling was used to identify significant predictors for CLABSI.
Results: 1,699 (58%) neonates received a central-line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (n=100, 63%). Nearly a 6-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1,000 line-days). Logistic mixed-modelling revealed longer central-line dwell-time (aOR:1.08, p<0.001), umbilical-lines (aOR:1.85, p=0.03) and single-rooms (aOR:3.63, p=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis.
Conclusions: CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
Reference:Jansen SJ, Broer SDL, Hemels MAC, Visser DH, Antonius TAJ, Heijting IE, Bergman KA, Termote JUM, Hütten MC, van der Sluijs JPF, d’Haens EJ, Kornelisse RF, Lopriore E, Bekker V. Central-line Associated Bloodstream Infection Burden among Dutch Neonatal Intensive Care Units. J Hosp Infect. 2023 Dec 14:S0195-6701(23)00396-1. doi: 10.1016/j.jhin.2023.11.020. Epub ahead of print. PMID: 38103692.