291. Primary blood stream infections in an outbreak in a neonatal Intensive care unit in Guatemala, 2012-2013
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • PIyengar.pdf (3.3 MB)
  • Background: Bloodstream infection (BSI) is the most frequent health care-associated infection in neonatal intensive care units (NICU) and an important cause of mortality and morbidity in neonates. We investigated a BSI outbreak in a NICU in Guatemala to determine rates of primary BSI and potential sources of infection.

    Methods: We performed a retrospective chart review of NICU admissions from November 2012-January 2013. A suspected case of BSI was defined as clinical sepsis based on clinical and laboratory parameters in a patient with negative or absent blood cultures. A confirmed case of BSI was defined as any infection in a patient documented by a positive blood culture. A case of primary BSI had no recognized source of infection; all other BSI cases were classified as secondary. Infection control practices were informally observed.

    Results: Of 116 patients admitted, 112 had charts available for review. Of these, 22 (20%) had blood cultures; 102 (91%) received antibiotic therapy. We identified 23 suspected and 8 confirmed cases of BSI; 11 (35%) had primary BSI and 20 (65%) had secondary BSI; the mortality among patients with primary BSI was 4/11 (36%). The incidence of primary BSI was 117 per 1000 patient-days; the median onset was 5 days (range, 0-10 days) after admission. The median duration of umbilical catheters before primary BSI was 5 days (range, 0-10 days). Among 11 patients with primary BSI, 2 (18%) were confirmed; one positive for Klebsiella spp., and one for Pseudomonas spp. Among 20 patients with secondary BSI, 6 (30%) were confirmed; 19 (95%) had documented radiographic evidence of pneumonia. Klebsiella spp. were isolated in 6 (75%) of the 8 positive cultures; all were resistant to third-generation cephalosporins and imipenem. Observed infection control lapses included lack of appropriate hand hygiene, injection safety, ventilator tube reprocessing, and contact precautions.

    Conclusion: Using blood cultures to guide treatment is not common practice in hospitals in Guatemala. Blood cultures were not drawn for most primary BSI cases; Carbapenem-resistant Klebsiella spp. was responsible for most confirmed BSI cases. Healthcare providers should improve blood culturing practices, antibiotic use, and infection control programs to decrease the rates of BSI and antimicrobial resistance.

    Preetha Iyengar, MD1, Eileen C. Farnon, MD1, Chris Bernart, MHS, PA-C2, Fernanda Lessa, MD3, Katherine Ellingson, PhD3, Aleida Roldan4 and Joe Bryan, MD5, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Universidad Del Valle De Guatemala, Guatemala City, Guatemala, Guatemala City, Guatemala, (3)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (4)Universidad Del Valle De Guatemala, Guatemala City, Guatemala, (5)Global Disease Detection Central America Regional Office, Guatemala City, Guatemala

    Disclosures:

    P. Iyengar, None

    E. C. Farnon, None

    C. Bernart, None

    F. Lessa, None

    K. Ellingson, None

    A. Roldan, None

    J. Bryan, None

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