Korean J healthc assoc Infect Control Prev 2023; 28(1): 113-125
Published online June 30, 2023 https://doi.org/10.14192/kjicp.2023.28.1.113
Copyright © Korean Society for Healthcare-associated infection Control and Prevention
Erdenetuya Bolormaa1*, Choryok Kang2*, Young June Choe3,4 , Joo Seon Heo3,5, Hannah Cho3
Department of Preventive Medicine, Korea University College of Medicine1, College of Nursing, Seoul National University2, Department of Pediatrics, Korea University Anam Hospital3, Allergy and Immunology Center, Korea University4, Institute of Nano, Regeneration, Reconstruction, Korea University College of Medicine, Korea University5, Seoul, Korea
Correspondence to: Young June Choe
E-mail: choey@korea.ac.kr
ORCID: https://orcid.org/0000-0003-2733-0715
*Equally contributed to the manuscript.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0).
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.
Keywords: Neonate, Bacteremia, Catheters, Infection control, Systematic review
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