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Central Line–Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: Developing a Candidate Definition for Mucosal Barrier Injury Bloodstream Infections

Published online by Cambridge University Press:  10 May 2016

Susan E. Coffin ,
Sarah B. Klieger ,
Christopher Duggan ,
W. Charles Huskins ,
Aaron M. Milstone ,
Gail Potter-Bynoe ,
Bram Raphael ,
Thomas J. Sandora ,
Xiaoyan Song  and
Danielle M. Zerr
...Show all authors
Susan E. Coffin*
Affiliation:
Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, and Department of Infection Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sarah B. Klieger
Affiliation:
Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, and Department of Infection Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Christopher Duggan
Affiliation:
Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
W. Charles Huskins
Affiliation:
Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Aaron M. Milstone
Affiliation:
Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Bram Raphael
Affiliation:
Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Xiaoyan Song
Affiliation:
Division of Infectious Diseases and Department of Pediatrics, Children’s National Medical Center, Washington, D.C.
Danielle M. Zerr
Affiliation:
Division of Infectious Diseases and Department of Pediatrics, University of Washington, Seattle, Washington
Grace M. Lee
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Pediatric Prevention EpiCenter Consortium
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
*
Division of Infectious Diseases, Children’s Hospital of Philadelphia, 3535 Market Street, Suite 1579, Philadelphia, PA 19104 (coffin@email.chop.edu).
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Abstract

Objective.

To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants

Design.

Multicenter retrospective cohort study.

Setting.

Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.

Methods.

A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.

Results.

During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).

Conclusions.

While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.

Infect Control Hosp Epidemiol 2014;35(11):1391–1399

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1391 - 1399
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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