Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
Gazi University, Faculty of Medicine, Department of Neonatology, Ankara, Turkey.
Pediatr Neonatol. 2021 Mar;62(2):208-217. doi: 10.1016/j.pedneo.2021.01.001. Epub 2021 Jan 19.
Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis.
A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey.
The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005).
Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.
医源性感染（HAI）在新生儿期会导致严重的发病率、死亡率和医疗保健费用。我们的目的是确定 HAI 的患病率、病原体的抗菌药物敏感性以及疾病控制与预防中心（CDC）标准在新生儿 HAI 诊断中的适应性。
在土耳其不同地理区域的 31 家医院的新生儿重症监护病房（NICU）进行了 HAI 点患病率调查。
HAI 的点患病率为 7.6%。呼吸机相关性肺炎（VAP）、中心静脉导管相关血流感染（CLABSI）和晚发性败血症是主要的感染类型。在我们的研究中，VAP 的点患病率为 2.1%，CLABSI 的点患病率为 1.2%。HAI 中最常见的病原体是革兰氏阴性杆菌（43.0%），最常见的病原体是克雷伯氏菌属（24.6%）；其中 81.2%为产超广谱β-内酰胺酶（ESBL）（+）。从脐静脉导管采集的样本中，有 33.3%的血培养阳性，而外周插入的中心导管（PICC）的样本中只有 0.9%为阳性。在我们的研究中，60%的经气管抽吸物培养阳性或有脓性气管分泌物的患者没有任何每日 FiO2 变化（p=0.67），80%的患者没有任何呼气末正压（PEEP）增加（p=0.7）。另一方面，18.1%的临床恶化与 VAP 相符的患者没有气管内培养阳性（p=0.005）。
新生儿 HAI 是地区和区域性医院中常见的不良事件。通过改进感染预防措施，应优先为高危人群制定 HAI 监测和预防计划，并且应加强手部卫生的依从性。CDC 诊断标准不适用于 NICU。需要进一步研究以诊断 NICU 中的 HAI。
