Central- and peripheral-line-associated bloodstream infections in Victorian neonatal intensive care units: findings from a comprehensive Victorian surveillance network, 2008-2024

Abstract

Background: Neonates face a high risk of healthcare-associated bloodstream infections, leading to increased morbidity and mortality. Effective surveillance is crucial for safe neonatal care and infection prevention.

Aim: To evaluate infection trends, pathogen distribution and antimicrobial resistance patterns in central- and peripheral-line-associated bloodstream infections (CLABSIs and PLABSIs) in Victorian Level 6 neonatal intensive care units between 1^st July 2008 and 30^th June 2024.

Methods: Data were collected by the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre using Centers for Disease Control and Prevention National Healthcare Safety Network guidelines. A retrospective data analysis of prospectively collected data was conducted to examine infection epidemiology.

Findings: Overall, 581 neonates developed CLABSIs or PLABSIs, corresponding to a mean CLABSI rate of 2.26 per 1000 central-line-days and a mean PLABSI rate of 0.60 per 1000 peripheral-line-days. The median age at diagnosis of all events was 16 days (interquartile range 9-35 days). No trends were observed in CLASBI or PLABSI rates over the study period. However, an increasing trend in CLABSI rates [incidence risk ratio (IRR) 1.04, 95% confidence interval (CI) 1.00-1.07; P=0.043] and a decreasing trend in PLABSI rates (IRR 0.95, 95% CI 0.92-0.99; P=0.021) were noted among neonates with birth weight ≤750 g. The most frequently reported organisms were coagulase-negative staphylococci, responsible for 44.0% of CLABSIs and 39.5% of PLABSIs.

Conclusion: Neonatal intensive care units in Victoria maintained low CLABSI and PLABSI rates over the study period. Higher infection rates in low-birthweight neonates emphasize the need for targeted infection prevention strategies for this vulnerable population.

Keywords: Bloodstream infection; Central-line-associated bloodstream infection; Epidemiology; Healthcare-associated infection; Neonatal intensive care unit; Peripheral-line-associated bloodstream infection; Surveillance.