Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants

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Summary

Infants with birthweight <1500 g (VLBW) are at high risk of healthcare-associated infection (HAI). We present surveillance data from the NEO-KISS surveillance system, collected between 2000 and 2005 by 52 neonatology departments in Germany. Infants were stratified into two birthweight categories (<1000 and 1000–1499 g), and rates of nosocomial bloodstream infection (BSI), nosocomial pneumonia and necrotising enterocolitis (NEC) were calculated. The data presented comprise 8677 VLBW and 339 972 patient-days. The incidence of bloodstream infection was 6.5 per 1000 patient-days (8.5 and 4.0 according to birthweight category). The incidence of central venous catheter (CVC)-associated BSI was 11.1 per 1000 CVC-days and the incidence of peripheral venous catheter (PVC)-associated BSI was 7.8 per 1000 PVC-days. The incidence of pneumonia was 0.9 per 1000 patient-days (1.3 and 0.4 according to birthweight category). The incidence of pneumonia among intubated patients was 2.7 per 1000 ventilator-days, while the incidence of pneumonia among patients receiving continuous nasel positive airway pressure (CPAP) was 1.0 per 1000 CPAP-days. The incidence of NEC was 0.9 per 1000 patient-days (1.1 and 0.6 according to birthweight category). HAI is frequent among VLBW and shows wide variation between neonatology departments. Preventive strategies to reduce infections in these infants should be prioritised.

Introduction

Advances in neonatal intensive care have improved survival among very-low-birthweight (VLBW) infants, but healthcare-associated infections (HAIs) remain an important cause of morbidity and mortality in this high-risk population.1, 2, 3, 4, 5, 6, 7, 8 Infected neonates spend more days on mechanical ventilation, experience longer and more expensive hospital stays, are at higher risk of developmental disorders and cerebral palsy, and have higher mortality.9, 10, 11, 12, 13, 14, 15, 16 Surveillance is one of the most important tools in the prevention of HAI.17, 18, 19, 20, 21 The epidemiology of HAI among neonates in neonatal intensive care units (NICUs) in the USA has been explored through the National Nosocomial Infection Surveillance (NNIS) system of the Centers for Disease Control and Prevention (CDC), but little information has been available from Europe.22, 23 We therefore developed a surveillance system for HAI among VLBW in NICUs called NEO-KISS (KISS: hospital infection surveillance system), with the aims of providing comparative data for the participating departments and of determining the incidence of HAI in NICUs in Germany as a whole.

Section snippets

Setting and patient population

NEO-KISS began in January 2000 as a prospective surveillance system for VLBW in Germany.24 By December 2005, 52 neonatology departments (48 with level III NICUs, four with combined level II/level III NICUs) had participated for periods of between 12 and 72 months. In NEO-KISS all VLBW infants (birthweight < 1500 g) admitted to participating NICUs are maintained under surveillance for the development of pneumonia, bloodstream infection (BSI) and necrotising enterocolitis (NEC), until discharge,

Results

Table I shows data for the period January 2000 to December 2005 NEO-KISS comprising 8677 VLBW and 339 972 patient-days from 52 departments. A total of 2832 HAI occurred in 2226 VLBW, so 25.7% of infants developed at least one HAI. The overall incidence density for HAI was 8.3 per 1000 patient-days. BSI was the most common HAI (N = 2218), followed by pneumonia (N = 314) and NEC (N = 300) (Table II). Although there were fewer infants in the <1000 g birthweight category (43%) most of the infections (73%)

Discussion

Standards for surveillance of HAI have been adopted in the USA, the UK, Australia and Canada.23, 26, 27, 28, 29 With 8677 VLBW from 52 departments the German NEO-KISS is one of the largest databanks focusing on HAI in VLBW. Comparing surveillance data from different countries is not straightforward. For example, rates of device utilisation vary widely between different countries, suggesting either differences in severity of illness of the patients under surveillance or differences in clinical

Acknowledgements

We wish to thank colleagues from the participating departments.

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