Antimicrobial Stewardship & Healthcare Epidemiology (Jun 2023)

Epidemiology of central-line–associated bloodstream infection mortality in Canadian NICUs before and after 2017

  • Maria Spagnuolo,
  • Anada Silva,
  • Jessica Bartoszko,
  • Linda Pelude,
  • Blanda Chow,
  • Jeannette Comeau,
  • Chelsey Ellis,
  • Charles Frenette,
  • Lynn Johnston,
  • Kevin Katz,
  • Joanne Langley,
  • Bonita Lee,
  • Santina Lee,
  • Marie-Astrid Lefebvre,
  • Allison McGeer,
  • Dorothy Moore,
  • Senthuri Paramalingam,
  • Jennifer Parsonage,
  • Donna Penney,
  • Caroline Quach,
  • Michelle Science,
  • Stephanie Smith,
  • Kathryn Suh,
  • Jocelyn Srigley

DOI
https://doi.org/10.1017/ash.2023.287
Journal volume & issue
Vol. 3
pp. s48 – s48

Abstract

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Background: The Canadian Nosocomial Infection Surveillance Program (CNISP) observed increased mortality among neonatal intensive care unit (NICU) patients with central-line–associated bloodstream infection (CLABSI) starting in 2017. In this study, we compared NICU patients with CLABSIs before and after 2017, and quantified the impact of epidemiological factors on 30-day survival. Methods: We included 1,276 NICU patients from 8–16 participating CNISP hospitals from the pre-2017 period (2009–2016) and the post-2017 period (2017–2022) using standardized definitions and questionnaires. We used Cox regression modeling to assess the impact of age at date of positive culture, sex, birthweight, CLABSI microorganism, region of the country, and surveillance period (before 2017 vs after 2017) on time to 30-day all-cause mortality from date of positive culture. Gestational age was not available for this analysis. We reported model outputs as hazard ratios with 95% CIs. Results: In total, 769 (60%) NICU CLABSIs were reported in the pre-2017 period and 507 (40%) in the post-2017 period. The 30-day all-cause mortality rate was 8% (n = 100 of 1,276) overall, and significantly higher after 2017 (12%, n = 61 of 507) than before 2017 (5%, n = 39 of 769) (P < .001).