Determinants of late neonatal nosocomial infection: a case-control study in Ceará

Development and Validation of a Nosocomial Infection Nomogram Model in the NICU: A Novel and Nurse-Led Way to Prediction in Preterm Infants

Purpose

Nosocomial infections (NI) are a leading cause of mortality in preterm infants in the Neonatal Intensive Care Unit (NICU). The key to reducing the risk of NI is early detection and treatment in time. Nurses are close observers and primary caregivers for neonates at the bedside of the NICU, who are best positioned to capture the risk signals of NI. This study aims to develop a nurse-led prediction model for NI of preterm infants in the NICU.

Patients and Methods

This study was designed as a retrospective study, preterm infants of the NICU at Renmin Hospital of Wuhan University from January 2020 to December 2023 were selected and divided into the NI group and non-NI group. Clinical data were collected and then analyzed by univariate analysis, least absolute shrinkage and selection operator (LASSO) regression analysis, and multivariate logistic regression analysis. The outcome constructed a nomogram model and its predictive efficacy was evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrap method was used to repeat 1,000 times for internal validation.

Results

A total of 892 preterm infants were finally included and a nurse-led predictive model established, which included six variables: skin color changes, respiratory related changes, feeding deterioration, birth weight, number of arterial and venous blood draws, and days of nasogastric tube placement. The model's AUC was 0.953, indicating good discriminatory power. The calibration plot demonstrated good calibration and the Hosmer-Lemeshow test showed high consistency. DCA indicated that the nomogram had good clinical utility. Internal validation showed the AUC of 0.952.

Conclusion

This nomogram model, which is mainly based on nurses' observations, shows good predictive ability. It offered a more convenient option for neonatologists and nurses in the NICU.

The Extra Length of Stay, Costs, and Mortality Associated With Healthcare-Associated Infections: A Case-Control Study

Background and Aim

This study aims to compare the mortality rate, length of stay (LOS), and hospitalization cost in patients with and without healthcare-associated infections (HCAIs).

Methods

This prospective cohort study is conducted on 396 matched patients admitted to a tertiary teaching hospital with 800 beds in the southwest of Iran from July 2021 to January 2022. The cases were patients admitted during the study period who had, at minimum, one type of HCAI. For a comparison group, we considered all patients without HCAIs who hospitalized in the same ward and at the same time with the same age and gender in a ratio of one case to three controls. Descriptive analyses were done based on direct medical costs, LOS, and mortality rate in patients. The magnitude of the relationship between potential risk factors and HCAI was quantified using logistic regression.

Results

The most common HCAI and microorganisms were urinary tract infection (UTI) and Escherichia coli, respectively. The mean LOS for infected patients was 20.3 (±16) days, compared to 8.7 (±8.6) days for noninfected patients (p value ≤ 0.05). Lengths of stay (odds ratio [OR] = 1.09; 95% CI = 1.06-1.19; p value = 0.000), ICU lengths of stay (OR = 1.08; 95% CI = 1.02-1.15; p value = 0.003), presence of central Catheter (OR = 0.127; 95% CI = 0.51-0.319; p value = 0.000), and urinary catheter (OR = 0.225; 95% CI = 0.122-0.415; p value = 0.000), mechanical ventilation (OR = 0.136; 95% CI = 0.57-0.325; p value = 0.000), receipt of immunosuppressors (OR = 1.99; 95% CI = 11.12-3.56; p value = 0.01), were Significantly associated with HCAI. Patients with infections had a more costly hospital stay than noninfected patients (mean diff: $2037.46 ([SD]: 482.25$) (p value = 0.000). The highest cost component was the cost of medication expenditure (mean: $1612.66 ([SD]: $2542.27).

Conclusions

UTI was the most common HCAI in our study. An infection acquired during a hospital stay may be associated with higher hospitalization costs, prolonged hospitalization, and an increase in the rate of mortality. Longer lengths of stay, presence of central and urinary Catheters, receipt of immunosuppressors, use of mechanical ventilator were common risk factors for HCAI. This study reveals that the median reimbursement cost per hospitalization of patients with HCAIs was higher than patients without HCAIs. This highlights the necessity for implementation of HCAI prevention and control measures.

Risk factors of multidrug-resistant organisms neonatal sepsis in Surabaya tertiary referral hospital: a single-center study

BACKGROUND

Bacterial organisms causing neonatal sepsis have developed increased resistance to commonly used antibiotics. Antimicrobial resistance is a major global health problem. The spread of Multidrug-Resistant Organisms (MDROs) is associated with higher morbidity and mortality rates. This study aimed to determine the risk factors for developing MDRO neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2020-2022.

METHODS

A cross-sectional study was performed on 113 eligible neonates. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Univariate and multivariate analysis with multiple logistic regression were performed to find the associated risk factors for developing multidrug-resistant organism neonatal sepsis. A p-value of < 0.05 was considered significant.

RESULTS

Multidrug-resistant organisms were the predominant aetiology of neonatal sepsis (91/113, 80.5%). The significant risk factors for developing MDRO neonatal sepsis were lower birth weight (OR: 1.607, 95% CI: 1.003 - 2.576, p-value: 0.049), history of premature rupture of the membrane (ProM) ≥ 18 (OR: 3.333, 95% CI: 2.047 - 5.428, p-value < 0.001), meconium-stained amniotic fluid (OR: 2.37, 95% CI: 1.512 - 3.717, p-value < 0.001), longer hospital stays (OR: 5.067, 95% CI: 2.912 - 8.815, p-value < 0.001), lower Apgar scores (OR: 2.25, 95% CI: 1.442 - 3.512, p-value < 0.001), and the use of respiratory support devices, such as invasive ventilation (OR: 2.687, 95% CI: 1.514 - 4.771, p-value < 0.001), and non-invasive ventilation (OR: 2, 95% CI: 1.097 - 3.645, p-value: 0.024).

CONCLUSIONS

Our study determined various risk factors for multidrug-resistance organism neonatal sepsis and underscored the need to improve infection control practices to reduce the existing burden of drug-resistant sepsis. Low-birth-weight, a maternal history of premature rupture of the membrane lasting more than 18 hours, meconium-stained amniotic fluid, longer hospital stays, a low Apgar score, and the use of ventilators were the risk factors for developing drug-resistant neonatal sepsis.