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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	20-27
Number of pages	8
Journal	Journal of Hospital Infection
Volume	144
DOIs	https://doi.org/10.1016/j.jhin.2023.11.020
Publication status	Published - 1 Feb 2024

Keywords

Central lines
Evaluation
Multi-centre
Neonates

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Cite this

Jansen, S. J., Broer, S. D. L., Hemels, M. A. C., Visser, D. H., Antonius, T. A. J., Heijting, I. E., Bergman, K. A., Termote, J. U. M., Hütten, M. C., van der Sluijs, J. P. F., d'Haens, E. J., Kornelisse, R. F., Lopriore, E., & Bekker, V. (2024). Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. Journal of Hospital Infection, 144, 20-27. https://doi.org/10.1016/j.jhin.2023.11.020

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title = "Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units",

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",

author = "Jansen, {S. J.} and Broer, {S. D.L.} and Hemels, {M. A.C.} and Visser, {D. H.} and Antonius, {T. A.J.} and Heijting, {I. E.} and Bergman, {K. A.} and Termote, {J. U.M.} and H{\"u}tten, {M. C.} and {van der Sluijs}, {J. P.F.} and d'Haens, {E. J.} and Kornelisse, {R. F.} and E. Lopriore and V. Bekker",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = feb,

day = "1",

doi = "10.1016/j.jhin.2023.11.020",

language = "English",

volume = "144",

pages = "20--27",

journal = "Journal of Hospital Infection",

issn = "0195-6701",

publisher = "W.B. Saunders Ltd",

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Jansen, SJ, Broer, SDL, Hemels, MAC, Visser, DH, Antonius, TAJ, Heijting, IE, Bergman, KA, Termote, JUM, Hütten, MC, van der Sluijs, JPF, d'Haens, EJ, Kornelisse, RF, Lopriore, E & Bekker, V 2024, 'Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units', Journal of Hospital Infection, vol. 144, pp. 20-27. https://doi.org/10.1016/j.jhin.2023.11.020

TY - JOUR

T1 - Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units

AU - Jansen, S. J.

AU - Broer, S. D.L.

AU - Hemels, M. A.C.

AU - Visser, D. H.

AU - Antonius, T. A.J.

AU - Heijting, I. E.

AU - Bergman, K. A.

AU - Termote, J. U.M.

AU - Hütten, M. C.

AU - van der Sluijs, J. P.F.

AU - d'Haens, E. J.

AU - Kornelisse, R. F.

AU - Lopriore, E.

AU - Bekker, V.

PY - 2024/2/1

Y1 - 2024/2/1

N2 - 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.

AB - 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.

KW - Central lines

KW - Evaluation

KW - Multi-centre

KW - Neonates

U2 - 10.1016/j.jhin.2023.11.020

DO - 10.1016/j.jhin.2023.11.020

M3 - Article

SN - 0195-6701

VL - 144

SP - 20

EP - 27

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

ER -