Abstract
Objective Health care-associated infections (HAIs) are important causes of morbidity and mortality
in neonatal intensive care units (NICUs). This study aimed to evaluate the frequency
of HAIs and related factors in the NICU.
Methods HAIs detected and monitored by daily active surveillance by the Infection Control
Team at Necmettin Erbakan University Faculty of Medicine NICU between January 1, 2017
and December 31, 2022 were evaluated retrospectively. There were a total of 43 incubators
in our hospital's NICU (19 secondary level units and 24 tertiary level). Between 2017
and 2022, there was an average of 982 admissions to the NICU per year.
Results A total of 5,895 newborns and 74,726 patient days were monitored in the study. The
average HAIs rate for all study years was 3.4% and the incidence density was 2.68
per thousand patient days. The highest HAI rate was in newborns with birth weights < 750 g.
A total of 201 HAIs were detected in 172 patients. Bloodstream infection (BSI) was
the most frequent HAI. The most frequent pathogens were Klebsiella spp. (44.8%), methicillin-resistant coagulase-negative staphylococci (CoNS) (24.4%),
and Acinetobacter spp. (11.6%). Note that 88.5% of Enterobacterales were extended-spectrum beta-lactamase
producers, and 26% of Klebsiella spp. were carbapenem-resistant. No colistin resistance was detected in Pseudomonas aeruginosa and Acinetobacter spp. Methicillin resistance was detected in 86.5% of CoNS and 50% of Staphylococcus aureus . The vancomycin resistance rate in Enterococcus spp. was 40%. Note that 16.7% of Candida spp. were fluconazole-resistant; no resistance to caspofungin was found. The most
common risk factors for development of HAI were prematurity, umbilical catheter use,
total parenteral nutrition, and mechanical ventilation. The mortality rate in patients
with HAIs was 20.9%.
Conclusion HAIs, including those caused by multidrug-resistant Gram-negative bacteria, are an
important problem in our hospital, and also globally. Active surveillance should be
continued, and changes over the years evaluated. Infection control programs should
be executed by determining the risk and mortality factors attributed to infection
and their implementation should be closely monitored. These practices will increase
success in the fight against HAIs and antimicrobial resistance.
Keywords neonatal intensive care unit - health care-associated infection - surveillance
