Nosocomial Infections in Very Low Birthweight Infants in Germany: Current Data from the National Surveillance System NEO-KISS

Abstract

Background:

Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insu­rance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants.

Patients and Methods:

We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients’ birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.

Results and Conclusion:

The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days. The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections.

Zusammenfassung

Hintergrund:

Frühgeborene mit einem Geburts­gewicht <1 500 g (VLBW – very low birthweight Neonaten) tragen ein hohes Risiko für nosoko­miale Infektionen (NI). Ab dem Jahr 2000 etab­lierten wir in Deutschland ein Surveillance System für VLBW Neonaten: NEO-KISS. Der Gemeinsame Bundesausschuss beschloss im Jahr 2005 VLBW Neonaten versorgende Abteilungen zur Teilnahme an NEO-KISS zu verpflichten. In der Folge hat sich NEO-KISS zu einem Deutschland-weiten Surveillance System für nosoko­miale Infektionen bei VLBW Neonaten entwickelt.

Patienten und Methoden:

In diesem Artikel stellen wir aktuelle NEO-KISS Daten dar, die zwischen 2007 und 2011 erhoben wurden. Berechnet wurden die Raten für Sepsis, Pneumonie und nekrotisierende Enterokolitis (NEC). Um Abteilungs-spezifische Infektionsraten besser beurteilen zu können, führen wir einen neuen Indikator ein: die Standardisierte Infektionsrate (SIR). Die SIR berücksichtigt die Risikostruktur der jeweiligen Abteilung (basierend auf dem Geburtsgewicht der Patienten) und beschreibt das Verhältnis von aufgetretenen zu erwarteten Infektionen.

Ergebnisse und Schlussfolgerung:

Im angegebenen ­Zei­traum sammelten wir Daten von 33 048 VLBW Neonaten. Die Inzidenzdichte der ZVK-assoziierten Sepsis betrug 8,6/1 000 ZVK Tage. Die Inzidenzdichte der Pneumonie war 0,6/1 000 Patiententage und der beatmungs-assoziierten Pneumonie 2,7 pro 1 000 Beatmungstage. Die Inzidenzdichte der NEC war 0,8/1 000 Patiententage. Die SIR-Werte der NEO-KISS Abteilungen weisen eine starke Variation auf. Die SIR ist ein ausgezeichnetes Mittel um Ausreißer bei NI zu identifizieren.

Key words

nosocomial infections - VLBW - surveillance - NICU

Schlüsselwörter

nosokomiale infektionen - frühgeborene - surveillance - krankenhausinfektion

• References

• 1 Polin RA, Denson S, Brady MT. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics 2012; 129: e1104-e1109
• 2 Sohn AH, Garrett DO, Sinkowitz-Cochran RL et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey. J Pediatr 2001; 139: 821-827
• 3 Haustein T, Gastmeier P, Holmes A et al. Use of benchmarking and public reporting for infection control in four high-income countries. Lancet Infect Dis 2011; 11: 471-481
• 4 Schwab F, Gastmeier P, Piening B et al. The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect. Antimicrob Resist Infect Control 2012; 1: 24
• 5 Geffers C, Baerwolff S, Schwab F et al. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect 2008; 68: 214-221
• 6 Schwab F, Geffers C, Barwolff S et al. Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J Hosp Infect 2007; 65: 319-325
• 7 Bloom BT, Craddock A, Delmore PM et al. Reducing acquired infections in the NICU: observing and implementing meaningful differences in process between high and low acquired infection rate centers. J Perinatol 2003; 23: 489-492
• 8 Valls i, Soler A, Madrid M et al. International Perspectives: Preventing Sepsis in VLBW infants: Experience from Neonatal Networks and Voluntary Surveillance Systems. Neo Reviews 2010; 11: e403, DOI: 410.1542/neo.1511-1548-e1403.
• 9 Vergnano S, Menson E, Kennea N et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011; 96: F9-F14
• 10 Isayama T, Lee SK, Mori R et al. Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 2012; 130: e957-e965
• 11 Murphy BP, Armstrong K, Ryan CA et al. Benchmarking care for very low birthweight infants in Ireland and Northern Ireland. Arch Dis Child Fetal Neonatal Ed 2010; 95: F30-F35
• 12 Dudeck MA, Horan TC, Peterson KD et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011; 39: 798-816
• 13 Bauer S, Busley A, Böhler T et al. G-5 Gutachten: Umsetzung der Vereinbarung über Maßnahmen zur Qualitätssicherung der Versorgung von Früh- und Neugeborenen; Fachbereich Evidenzbasierte Medizin MDdSBdKeV. editor Essen: Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V; 2009: 201 p.
• 14 Cipolla D, Giuffre M, Mammina C et al. Prevention of nosocomial infections and surveillance of emerging resistances in NICU. J Matern Fetal Neonatal Med 2011; 24 (Suppl. 01) 23-26
• 15 Edwards JR, Peterson KD, Andrus ML et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007; 35: 290-301
• 16 Gastmeier P, Behnke M, Breier AC et al. Healthcare-associated infection rates: measuring and comparing: Experiences from the German national nosocomial infection surveillance system (KISS) and from other surveillance systems. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 1363-1369
• 17 Rosenthal VD, Lynch P, Jarvis WR et al. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection 2011; 39: 439-450
• 18 Sievert DM, Ricks P, Edwards JR et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the national healthcare safety network at the centers for disease control and prevention, 2009–2010. Infect Control Hosp Epidemiol 2013; 34: 1-14
• 19 Chitnis AS, Magill SS, Edwards JR et al. Trends in Candida central line-associated bloodstream infections among NICUs, 1999–2009. Pediatrics 2012; 130: e46-e52