Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units

S J Jansen; S D L Broer; M A C Hemels; D H Visser; T A J Antonius; I E Heijting; K A Bergman; J U M Termote; M C Hütten; J P F van der Sluijs; E J d'Haens; R F Kornelisse; E Lopriore; V Bekker

doi:10.1016/j.jhin.2023.11.020

Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units

J Hosp Infect. 2024 Feb:144:20-27. doi: 10.1016/j.jhin.2023.11.020. Epub 2023 Dec 14.

Authors

S J Jansen¹, S D L Broer², M A C Hemels³, D H Visser⁴, T A J Antonius⁵, I E Heijting⁵, K A Bergman⁶, J U M Termote⁷, M C Hütten⁸, J P F van der Sluijs⁹, E J d'Haens³, R F Kornelisse¹⁰, E Lopriore², V Bekker²

Affiliations

¹ Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands. Electronic address: s.j.jansen@lumc.nl.
² Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
³ Department of Neonatology, Isala, Zwolle, The Netherlands.
⁴ Emma Children's Hospital, Department of Paediatrics, Division of Neonatology, Amsterdam University Medical Centre (AUMC), Location AMC, Amsterdam, The Netherlands.
⁵ Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands.
⁶ Beatrix Children's Hospital, Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
⁷ Wilhelmina Children's Hospital, Department of Neonatology, Division of Mother and Child, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
⁸ Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
⁹ Department Paediatrics, Division of Neonatology, Máxima Medical Centre (MMC), Veldhoven, The Netherlands.
¹⁰ Erasmus MC - Sophia Children's Hospital, Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands.

PMID: 38103692
DOI: 10.1016/j.jhin.2023.11.020

Abstract

Background: The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives.

Aim: To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs).

Methods: Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI.

Results: A total of 1699 (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%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (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.

Keywords: Central lines; Evaluation; Multi-centre; Neonates.

Publication types

Observational Study

MeSH terms

Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous*
Cohort Studies
Cross Infection* / epidemiology
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care Units
Intensive Care Units, Neonatal
Retrospective Studies
Sepsis* / epidemiology