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Open Access Research article

Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009–2011

Jadwiga Wójkowska-Mach1*, Ewa Gulczyńska2, Marek Nowiczewski2, Maria Borszewska-Kornacka3, Joanna Domańska4, T Allen Merritt5, Ewa Helwich6, Agnieszka Kordek7, Dorota Pawlik8, Janusz Gadzinowski9, Jerzy Szczapa9, Paweł Adamski10, Małgorzata Sulik3, Jerzy Klamka4, Monika Brzychczy-Włoch1 and Piotr B Heczko1

Author Affiliations

1 Microbiology, Jagiellonian University Medical College, 18 Czysta Street, Krakow 31-121, Poland

2 Clinic of Neonatology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland

3 Clinic of Neonatology and Intensive Neonatal Care, Warsaw Medical University, Warszawa, Poland

4 Institute of Theoretical and Applied Informatics of Polish Academy of Sciences, Gliwice, Poland

5 Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA

6 Clinic of Neonatology and Intensive Neonatal Care, Institute of Mother and Child, Warszawa, Poland

7 Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland

8 Clinic of Neonatology, Jagiellonian University Medical College, Krakow, Poland

9 Department of Neonatology, Poznan University of Medical School, Poznan, Poland

10 Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland

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BMC Infectious Diseases 2014, 14:339  doi:10.1186/1471-2334-14-339

Published: 18 June 2014

Abstract

Background

Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011.

Methods

The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS.

Results

Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%).

Conclusions

Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.