Korean J healthc assoc Infect Control Prev.  2023 Jun;28(1):113-125. 10.14192/kjicp.2023.28.1.113.

Epidemiology of Catheter-related Bloodstream Infections in Neonatal Intensive Care Units: A Rapid Systematic Literature Review

• Bolormaa E
• Kang C
• Choe YJ
• Heo JS
• Cho H

• KMID: 2543142
• DOI: http://doi.org/10.14192/kjicp.2023.28.1.113

Abstract

Background
Catheter-related bloodstream infections (CRBSIs) are serious complications in neonatal intensive care units (NICUs). We aimed to assess the incidence of CRBSIs in NICUs worldwide and describe the causative organisms.
Methods
We searched PubMed, EMBASE, Cochrane, and KoreaMed databases. We included studies on CRBSIs in NICU settings with data on bacteremia. We performed a random-effects meta-analysis on CRBSI incidence in NICUs, stratified the data according to WHO regions. We compiled data on underlying organisms.
Results
Of the 692 studies identified, 71 published between 2011 and 2022 were considered eligible. The pooled incidence of CRBSI per 1000 catheter days in NICUs was 8.66 (95% confidence interval [CI], 7.19; 10.12). Stratifying by WHO regions, the CRBSI incidence per 1000 catheter days was 10.38 (95% CI, 3.86; 16.90) in the Eastern Mediterranean Region (EMR), 11.77 (95% CI, 9.20; 14.35) in the European Union Region (EUR), 5.94 (95% CI, 3.87; 8.00) in the Western Pacific Region (WPR), and 6.71 (95% CI, 4.39; 9.03) in the Region from the Americas (AMR). Of the 2887 bacterial strains, 73.4% (n=2118) were gram-positive bacteria, 18.9% (n=547) were gram-negative bacteria, and 7.8% (n=225) were fungi. Coagulasenegative Staphylococci (n=1380, 65.2%) were the most common pathogen among the grampositive types, followed by Staphylococcus aureus (n=318, 15%). Among the CRBSI gramnegative cultures, Klebsiella spp. (n=201, 36.7%) was the primary pathogen.
Conclusion
We found a substantial burden of CRBSIs in NICUs across the globe. Our findings highlight the need to improve the implementation of global and local strategies to reduce CRBSIs in NICUs.

Keyword

Neonate; Bacteremia; Catheters; Infection control; Systematic review

Figure

• 

  Fig. 1 Flowchart of the study selection. Abbreviations: NICU, neonatal intensive care unit; CRBSI, catheter-related bloodstream infection.

• 

  Fig. 2 Forest plot for catheter-related bloodstream infections per 1000 catheter days in the different World Health Organization regions, 2002-2020. (A) Eastern Mediterranean, Europe, (B) Western Pacific and Americas. Abbreviations: EMR, Eastern Mediterranean Region; EUR, European Union Region; WPR, Western Pacific Region; AMR, Region from America.

• 

  Fig. 3 Trend of catheter-related bloodstream infections per 1000 catheter days in neonatal intensive units by surveillance periods.

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  Fig. 4 The proportions of pathogens identified from catheter-related bloodstream infections in different World Health Organization regions, 2006-2016. Abbreviations: AMR, Region from America; WPR, Western Pacific Region; EUR, European Union Region.

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