72 - Applicability of CDC’s National Healthcare Safety Network (NHSN) Definitions for Secondary Bloodstream Infections (BSI) in the Neonatal Intensive Care Unit (NICU) Population

Poster Number: 72
Publication Number: 72.437

Eliza Gentzler, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Irene Frantzis, Columbia University Medical Center, New York, NY, United States; Anshu Paul, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Kyra E. Solowey, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Surya Manickam, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; maria messina, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Luis R. Alba, Columbia University Medical Center, New York, NY, United States; Candace Johnson, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Sandhya S. Brachio, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Lisa Saiman, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Active surveillance to identify and report central line-associated bloodstream infections (CLABSI) in the NICU have been implemented in the U.S. using CDC NHSN criteria. While NHSN criteria are used to define BSI secondary to infections at another site, the real-world applicability of these criteria and the burden of secondary BSI in the NICU population have not been systematically studied. 

Objective:
1.   To evaluate applicability of NSHN criteria for secondary BSI in the NICU population  2.   To describe the most common NHSN criteria for secondary BSI that are lacking in the NICU population  

Design/Methods: This retrospective study included all infants with positive blood cultures obtained >72 hours of life admitted to a Level IV NICU from 2010-2019. Infants were excluded if transferred to the study NICU after day of life 7, if BSIs occurred at another hospital, or if positive blood cultures were determined to be contaminants. Clinical, laboratory and radiographic findings that supported the 2021 NHSN criteria for secondary BSIs were collected. NICU provider notes and infectious diseases consults were reviewed for their diagnosis of the primary source of infection thought to result in BSI. Data analysis included the frequency of primary sources, proportion of secondary BSIs meeting NHSN criteria, and which NHSN criteria were most consistently lacking. 

Results: Among 252 eligible BSI episodes, 112 (44%) were considered to be secondary BSIs while 65 (26%) fulfilled NHSN CLABSI criteria. Among secondary BSIs, 59/112 (53%) fully met NHSN criteria. Table 1 provides the frequency of each primary source for secondary BSIs and the proportion meeting NHSN criteria. Necrotizing enterocolitis (NEC) was the most common primary source diagnosed and most likely to fulfill NHSN criteria. Meningitis was the second most common primary source diagnosed and least likely to fulfill criteria. 93% of infants with BSI secondary to meningitis lacked meningeal or cranial nerve signs and 78% of infants with BSIs secondary to pneumonia lacked serial imaging studies with reported opacity or consolidation.  Conclusion(s): NEC is a neonatal-specific diagnosis and most likely to meet full NHSN criteria. However, criteria for secondary BSIs are often not met in infants in the NICU despite clinical diagnosis of a primary source of infection. Use of NHSN criteria potentially underestimates the burden of secondary BSI. Modification of NHSN criteria for the NICU population could facilitate more accurate surveillance for the etiologies of BSI.  
Table 1. Primary Sources of Infection associated with Secondary BSIs and Proportion Meeting NHSN Criteria