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

Susan E. Coffin MD MPH, Sarah B. Klieger MPH, Christopher Duggan MD MPH, W. Charles Huskins MD MSC, Aaron M. Milstone MD MHS, Gail Potter-Bynoe BS CIC, Bram Raphael MD, Thomas J. Sandora MD MPH, Xiaoyan Song MD PhD, Danielle M. Zerr MD MPH, Grace M. Lee MD MPH and Pediatric Prevention EpiCenter Consortium
Infection Control and Hospital Epidemiology
Vol. 35, No. 11 (November 2014), pp. 1391-1399
DOI: 10.1086/678410
Stable URL: http://www.jstor.org/stable/10.1086/678410
Page Count: 9
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Central Line–Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: Developing a Candidate Definition for Mucosal Barrier Injury Bloodstream Infections
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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.

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