Division of Clinical Sciences, Paediatric Infectious Disease Research Group, St George's University of London, , London, UK.
Arch Dis Child Fetal Neonatal Ed. 2013 Nov;98(6):F518-23. doi: 10.1136/archdischild-2012-303149. Epub 2013 May 4.
To examine the reporting of hospital-acquired bloodstream infection (HABSI) and central line-associated BSI (CLABSI) rates in neonatal intensive care units (NICUs).
Systematic review of evidence published after 2000 reporting HABSI cumulative incidence, crude HABSI and/or CLABSI rate and total patient-days and/or central line-days for single NICU.
Inpatient.
Neonates admitted to NICU.
To consider the reporting of and relationship between cumulative incidence of BSI and HABSI and/or CLABSI rates.
18 studies fulfilled inclusion criteria. There was a wide variability in reporting of HABSI indicators and risk-adjustment strategies with reported crude HABSI and/or CLABSI rates showing an approximately sevenfold variation between centres. Information about NICU size and level of care was not always available. Many studies provided insufficient information about case mix, such as surgical care provision and prematurity. The proportion of total patient-days that were central venous catheters (CVC)-days ranged from 11.7% to 85.4%. Only six studies reported HABSI and CLABSI incidence. Comparing HABSI and CLABSI ranking, we found a relationship between rates.
We found significant variability in HABSI rate reporting. Although there appears to be an association between CLABSI and HABSI rates, non-CVC-related BSIs are likely to be highly relevant in some NICUs. If confirmed, and given CLABSI rates are more challenging to collect, it may be more appropriate to use HABSI rates for monitoring NICU healthcare-associated infection (HAI) in some settings. A European network of NICUs using a standardised methodology is required to determine the feasibility and reliability of different risk-adjusted measured of HAI rates.
调查新生儿重症监护病房（NICU）医院获得性血流感染（HABSI）和中心静脉相关血流感染（CLABSI）报告率。
对 2000 年后发表的报告 HABSI 累积发病率、HABSI 和/或 CLABSI 粗率以及单个 NICU 总患者天数和/或中心静脉置管天数的证据进行系统评价。
住院部。
入住 NICU 的新生儿。
考虑 BSI 累积发病率和 HABSI 和/或 CLABSI 率的报告和关系。
18 项研究符合纳入标准。HABSI 指标的报告和风险调整策略存在很大差异，报告的 HABSI 和/或 CLABSI 粗率在中心之间存在约 7 倍的差异。关于 NICU 规模和护理水平的信息并不总是可用。许多研究提供了关于病例组合的信息不足，例如手术护理提供和早产。总患者天数中中心静脉置管（CVC）天数的比例范围为 11.7%至 85.4%。只有 6 项研究报告了 HABSI 和 CLABSI 的发生率。比较 HABSI 和 CLABSI 的排名，我们发现两者之间存在相关性。
我们发现 HABSI 报告率存在显著差异。尽管 CLABSI 和 HABSI 率之间似乎存在关联，但某些 NICU 中非 CVC 相关的 BSIs 可能非常重要。如果得到证实，并且由于 CLABSI 率更难收集，在某些情况下，使用 HABSI 率来监测 NICU 医院获得性感染（HAI）可能更为合适。需要建立一个使用标准化方法的欧洲 NICU 网络，以确定不同风险调整的 HAI 率测量方法的可行性和可靠性。
