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Determinants of Nosocomial Infection in 6 Neonatal Intensive Care Units: An Italian Multicenter Prospective Cohort Study

Published online by Cambridge University Press:  02 January 2015

Cinzia Auriti ,
Maria Paola Ronchetti ,
Patrizio Pezzotti ,
Gabriella Marrocco ,
Anna Quondamcarlo ,
Giulio Seganti ,
Francesco Bagnoli ,
Claudio De Felice ,
Giuseppe Buonocore  and
Cesare Arioni
...Show all authors
Cinzia Auriti*
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Maria Paola Ronchetti
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Patrizio Pezzotti
Affiliation:
Agency for Public Health, Lazio, Rome
Gabriella Marrocco
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Anna Quondamcarlo
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Giulio Seganti
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Francesco Bagnoli
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Claudio De Felice
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Giuseppe Buonocore
Affiliation:
Department of Neonatal Pathology and Neonatal Intensive Care, Le Scotte University Hospital, Siena
Cesare Arioni
Affiliation:
Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Giovanni Serra
Affiliation:
Department of Neonatal Pathology, G. Gaslini Institute, IRCCS, Genova
Gianfranco Bacolla
Affiliation:
Department of Neonatology and Neonatal Intensive Care, Burlo Garofalo Institute, IRCCS, Trieste
Giovanna Corso
Affiliation:
Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
Savino Mastropasqua
Affiliation:
Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
Annibale Mari
Affiliation:
Neonatal Intensive Care Unit, General Hospital, Cosenza, Italy
Carlo Corchia
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Domenico Di Lallo
Affiliation:
Agency for Public Health, Lazio, Rome
Lucilla Ravà
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Marcello Orzalesi
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
Vincenzo Di Ciommo
Affiliation:
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
*
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S. Onofrio, 4, 00165 Rome, Italy ([email protected])
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Abstract

Background.

Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs).

Objective.

To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection.

Design.

A multicenter, prospective cohort study.

Patients and Setting.

A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay.

Methods.

Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated.

Results.

A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95% CI, 1.5-3.5]).

Conclusions.

Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 9 , September 2010 , pp. 926 - 933
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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