Bloodstream infections in neonates with central venous catheters in three tertiary neonatal intensive care units in Pune, India

Article type: Research Article

Authors: Kartikeswar, G.A.P.^a | Parikh, T.B.^{a; *} | Randive, B.^b | Kinikar, A.^c | Rajput, U.C.^c | Valvi, C.^c | Vaidya, U.^a | Malwade, S.^d | Agarkhedkar, S.^d | Kadam, A.^b | Smith, R.M.^e | Westercamp, M.^e | Schumacher, C.^f | Mave, V.^{b; g} | Robinson, M.L.^g | Gupta, A.^g | Milstone, A.M.^h | Manabe, Y.C.^g | Johnson, J.^{i; j; *}

Affiliations: [a] Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India | [b] Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India | [c] Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India | [d] Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India | [e] Centers for Disease Control and Prevention, Atlanta, GA, USA | [f] Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [g] Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [h] Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [i] Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [j] Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence: [*] Address for correspondence: Tushar B. Parikh, DM, Department of Pediatrics, Division of Neonatology, KEM Hospital, Rasta Peth, Pune, 411011, India. E-mail: [email protected] and Julia Johnson, MD, PhD, Department of Pediatrics, Division of Neonatology, The Charlotte R. Bloomberg Children’s Center, 1800 Orleans Street, Suite 8534, Baltimore, MD 21287, USA. Tel.: +1 410 502 6794; Fax: +1 410 614 8388; E-mail: [email protected].

Abstract: BACKGROUND:Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS:We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. RESULTS:During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). CONCLUSIONS:We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.

Keywords: Antimicrobial resistance, bloodstream infection, central line-associated bloodstream infection, healthcare-associated infection

DOI: 10.3233/NPM-221110

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 507-516, 2023