Healthcare-associated infection in neonates and risk factors: A four-year surveillance study (2020–2024)

INTRODUCTION: Healthcare-associated infections (HAIs) represent a significant source of morbidity and mortality in neonatal intensive care units (NICUs). During the neonatal period, risk factors include prematurity, an immature immune system, invasive procedures, and prolonged hospitalization. This study aimed to identify the causative agents and risk factors associated with HAIs.
METHODS: This study encompassed 297 patients who were hospitalized in the NICU and diagnosed with HAIs between January 1, 2020, and December 30, 2023. Demographic, clinical, and laboratory data were retrospectively analyzed.
RESULTS: According to the type of HAIs, bloodstream infection (BSI) accounted for 53% (n=158), central line-associated BSI (CLABSI) for 4.3% (n=13), urinary tract infection for 8.7% (n=26), ventilator-associated pneumonia (VAP) for 0.3% (n=1), bone and joint infection for 1% (n=3), and skin and soft tissue infection for 1.3% (n=4). The CLABSI and VAP rates were 5.45 and 1.67, respectively. The overall mortality rate was 3% (n=9). The most commonly isolated agents were Gram-positive bacteria (79.8%), Gram-negative bacteria (17.8%), and Candida spp. (2.4%). Statistically significant differences were observed in prematurity (p=0.010), birth weight (p<0.001), mode of delivery (p=0.010), postnatal days (p=0.012), duration of hospitalization (p=0.004), mechanical ventilation (p=0.009), operation (p=0.031), presence of total parenteral nutrition (p<0.001), and central venous catheter use (p<0.001) between the groups.
DISCUSSION AND CONCLUSION: Consistent with the existing literature, Gram-positive microorganisms were identified as the predominant causative agents of HAIs. However, the incidence of Gram-negative bacteria and Candida spp. increased in the presence of specific risk factors. Identifying causative agents and associated risk factors is crucial for mitigating HAIs in the NICU.

Keywords: Bloodstream infection, healthcare-associated infections, neonatal intensive care unit.