Risk Factors for Health Care-Associated Bloodstream Infections in NICUs.

Summary

Across 6410 NICU admissions, device use in the preceding 3 days and first-week antibiotic exposure were major risk factors for healthcare-associated BSI. Gram-negative organisms predominated with high cephalosporin and carbapenem resistance, underscoring prevention and stewardship priorities.

Key Findings

• Healthcare-associated BSI incidence: 6.09 per 1000 patient-days among 6410 neonates.
• Gram-negative organisms predominated; 85.5% resistant to 3rd/4th-gen cephalosporins and 44.8% to carbapenems.
• Central venous catheters, respiratory support, and urinary catheters increased hazard; first-week antibiotics raised BSI risk nearly threefold (aHR 2.82).

Clinical Implications

Prioritize device bundles, minimize catheter dwell time, and limit empiric antibiotic exposure in the first week when safe; integrate stewardship with infection prevention.

Limitations

• Generalizability may be limited to similar NICU settings; residual confounding cannot be excluded.
• BSI defined by culture positivity from day 3 onward may miss culture-negative infections.

Future Directions

Cluster-randomized trials of device bundle optimization and early antibiotic stewardship pathways; implementation science to adapt strategies in diverse LMIC NICUs.