Trends in late‐onset sepsis in a neonatal intensive care unit following implementation of infection control bundle: A 15‐year audit

AbstractExtensively drug-resistant Acinetobacter baumannii (XDRAB) is a rapidly emerging pathogen causing threat to health care settings. The resultant morbidity and mortality rates are high due to limited therapeutic options. The present study demonstrates the characteristics of neonates, infected or colonized with XDRAB, antibiotic susceptibility patterns of the isolates, and neonatal outcomes. This retrospective study was conducted in the neonatal intensive care unit (NICU) of Dallah hospital, Riyadh, Saudi Arabia during the period January 2015 to December 2017. All neonates with positive XDRAB cultures from any location in the body were included, infected and colonized cases were compared. XDRAB was isolated from 16 neonates. Seventy-five percent of the affected neonates were preterm, with a median gestational age and birth weight of 32.5 weeks and 1,675 g, respectively. The median time to XDRAB infection/colonization for all cases was 14 days. Seventy-five percent of the cases had central venous catheters and 50 percent had surgery/procedure performed during stay in NICU. Half of the affected neonates had underlying congenital anomalies and chronic medical conditions. Fourteen affected neonates (87%) received prior courses of cefotaxime. In 15 of 16 cases, XDRAB infection manifested clinically as late-onset sepsis with bacteremia and ventilator-associated pneumonia (VAP). XDRAB isolates were resistant to all β-lactams and carbapenems. Resistance rate to other antibiotics was 93% for gentamicin and 50% for ciprofloxacin. All XDRAB isolates were susceptible to colistin. Seventy-five percent of the infected neonates died due to XDRAB sepsis, while 37% of the colonized group died of other underlying diseases. Fifty percent of the infected neonates died within 4 days of XDRAB infection. Prematurity, low birth weight, the use of vascular devices, and prior use of cefotaxime played a major role in XDRAB infection/colonization in our unit. It is crucial to consider early start of colistin, either alone or in combination therapy, especially for the neonates at high risk, for example, those with certain underlying chronic conditions who manifest with late-onset sepsis and/or VAP.

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ADEQUACY OF VANCOMYCIN/GENTAMYCIN AS EMPIRICAL REGIMEN IN TREATMENT OF LATE ONSET SEPSIS: RETROSPECTIVE STUDY IN NEONATAL INTENSIVE CARE UNIT IN UAE

10.26226/morressier.58fa1766d462b80290b5124d ◽

2017 ◽

Author(s):

Aisha Al Khaaldi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Late Onset ◽

Late Onset Sepsis

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A Quality Improvement Initiative to Reduce Central Line–Associated Bloodstream Infections in a Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/650448 ◽

2010 ◽

Vol 31 (3) ◽

pp. 241-248 ◽

Cited By ~ 92

Author(s):

Matthew J. Bizzarro ◽

Barbara Sabo ◽

Melanie Noonan ◽

Mary-Pat Bonfiglio ◽

Veronika Northrup ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Confidence Interval ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Late Onset ◽

Central Line ◽

Published Data ◽

Late Onset Sepsis

Objective.To reduce the rate of late-onset sepsis in a neonatal intensive care unit (NICU) by decreasing the rate of central line–associated bloodstream infection (CLABSI).Methods.We conducted a quasi-experimental study of an educational intervention designed to improve the quality of clinical practice in an NICU. Participants included all NICU patients with a central venous catheter (CVC). Data were collected during the period from July 1, 2005, to June 30, 2007, to document existing CLABSI rates and CVC-related practices. A multidisciplinary quality improvement committee was established to review these and published data and to create guidelines for CVC placement and management. Educational efforts were conducted to implement these practices. Postintervention CLABSI rates were collected during the period from January 1, 2008, through March 31, 2009, and compared with preintervention data and with benchmark data from the National Healthcare Safety Network (NHSN).Results.The rate of CLABSI in the NICU decreased from 8.40 to 1.28 cases per 1,000 central line–days (adjusted rate ratio, 0.19 [95% confidence interval, 0.08–0.45]). This rate was lower than the NHSN benchmark rate for level III NICUs. The overall rate of late-onset sepsis was reduced from 5.84 to 1.42 cases per 1,000 patient-days (rate difference, −4.42 cases per 1,000 patient-days [95% confidence interval, −5.55 to −3.30 cases per 1,000 patient-days]).Conclusions.It is possible to reduce the rate of CLABSI, and therefore the rate of late-onset sepsis, by establishing and adhering to evidence-based guidelines. Sustainability depends on continued data surveillance, knowledge of medical and nursing literature, and timely feedback to the staff. The techniques established are applicable to other populations and areas of inpatient care.

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An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala

American Journal of Infection Control ◽

10.1016/j.ajic.2012.02.031 ◽

2012 ◽

Vol 40 (6) ◽

pp. 516-520 ◽

Cited By ~ 16

Author(s):

Jennifer Gray ◽

Wences Arvelo ◽

John McCracken ◽

Beatriz Lopez ◽

Fernanda C. Lessa ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Late Onset ◽

Late Onset Sepsis

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