BLOOD-STREAM INFECTIONS IN NEONATAL INTENSIVE-CARE UNIT PATIENTS - RESULTS OF A MULTICENTER STUDY

For identification of risk factors for bloodstream infection (BSI) amo ng neonatal intensive care unit patients, prospective 6-month studies in three neonatal intensive care units were conducted. BSI was diagnos ed in 42 of 376 (11.2%) enrolled infants. Pathogens included coagulase -negative staphylococci, Candida sp., Group B streptococci and Gram-ne gative species. Patients with BSIs were more likely to die during thei r neonatal intensive care unit stay than were patients who did not acq uire BSIs (6 of 42 vs. 11 of 334, P = 0.007). BSI rate was highest in infants with birth weight <1500 g (relative risk (RR) = 6.8, P<0.001), those treated with H-2 blockers (RR = 4.2, P<0.001) or theophylline ( RR = 2.8, P<0.001) and those with admission diagnoses referable to the respiratory tract (RR = 3.7, P<0.001). Infants who developed BSI were more severely ill on admission than other infants (median physiologic stability index 13 vs. 10 (P<0.001) and were of lower gestational age (28 vs. 35 weeks, P<0.001). In logistic regression analysis, risk of ESI was independently associated only with very low birth weight, resp iratory admission diagnoses and receipt of H-2 blockers. Risk of isola tion of a pathogen from blood culture was independently associated wit h Broviac, umbilical vein or peripheral venous catheterization >10, 7 or 3 days, respectively, at one insertion site. Rate of isolation of a pathogen was higher (9 of 59 (15%)) within 48 hours of a measurable s erum interleukin 6 concentration than an interleukin 6 level of 0 pg/m l (10 of 159 (6%), P = 0.04). Conversely >1 day of exposure to gentami cin or ampicillin before the sepsis evaluation was associated with low er BSI risk in infants with intravascular catheters (20 of 127 (16%) v s. 9 of 16 (56%), P = 0.06). These findings indicate that very low bir th weight, respiratory diagnoses, H-2 blocker use and prolonged intrav ascular catheterization at one insertion site are associated with elev ated risk of BSI. Clinical trials of interventions addressing these ri sk factors are warranted.