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

Lima, Carmen Sulinete Suliano da Costa; Rocha, Hermano Alexandre Lima; Araújo, David Augusto Batista Sá; Silva, Cláudia

doi:10.11606/s1518-8787.2022056003291

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Sumário

Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003291 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES

To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care.

METHODS

This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant.

RESULTS

Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56–0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30–0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84–35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12–5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26–9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54–7.69); central venous catheters (OR = 10.00; 95%CI: 6.66–16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02–5.12); surgery (OR = 4.00; 95%CI: 2.27–7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83–17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26–2.68); central venous catheters (OR = 2.48; 95%CI: 1.40–4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections.

CONCLUSION

Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

Infant, Newborn; Infant, Premature; Cross Infection, epidemiology; Drug Resistance, Multiple, Bacterial; Risk Factors; Case-Control Studies

	Late HAIs		OR (95%CI)	p
	Present (n = 427) Cases	Absent (n = 705) Control	OR (95%CI)	p
Sex	n (%)	n (%)		0.0065^b
Feminine	193 (45.2%)	261 (37.0%)	0.71 (0.56–0.90)
Masculine	234 (54.8%)	444 (63.0%)	1.0
Gestational age classes	n (%)	n (%)		< 0.0001^b
≥ 37 weeks	122 (28.6%)	303 (43.0%)	1.0
34 to 36 weeks	29 (6.8%)	151 (21.4%)	0.48 (0.30–0.75)	0.0012^a
30 to 33 weeks	186 (43.6%)	239 (33.9%)	1.93 (1.45–2.57)	< 0.0001^a
< 30 weeks	90 (21.1%)	12 (1.7%)	18.61 (9.84–35.22)	< 0.0001^a
Birth weight (g)				< 0.0001^a
n	427	705
Median (min-max)	1,405 (415–5,085)	2,370 (550–6,200)
Birth weight classes	n (%)	n (%)		< 0.0001^b
> 2,500g	118 (27.6%)	327 (46.4%)	1.0
Between 1,500g and 2,499g	78 (18.3%)	225 (31.9%)	0.96 (0.69–1.34)	0.8131^a
< 1,500g	231 (54.1%)	153 (21.7%)	4.18 (3.12–5.61)	< 0.0001^a
Underweight	n (%)	n (%)		< 0.0001^b
> 2,500g	118 (27.6%)	327 (46.4%)	1.0
< 2,500g	309 (72.4%)	378 (53.6%)	2.27 (1.75–2.94)	< 0.0001^a
Fifth-minute Apgar < 8				< 0.0001^a
n	385	652
Median (min-max)	7.0 (0.0–10.0)	8.0 (1.0–10.0)
Asphyxia	n (%)	n (%)		< 0.0001^b
Omitted values	42	53
Apgar ≥ 7	229 (59.5%)	528 (81.0%)	1.0
Apgar < 7	156 (40.5%)	124 (19.0%)	2.94 (2.17–3.84)	< 0.0001^a

	Late HAIs		OR (95%CI)	p
	Present (n = 427) Cases	Absent (n = 705) Control	OR (95%CI)	p
Use of mechanical ventilation	n (%)	n (%)		< 0.0001^b
No	76 (17.8%)	426 (60.4%)	1.0
Yes	351 (82.2%)	279 (39.6%)	7.14 (5.26–9.09)	< 0.0001^a
Ventilation period (days)			1.15 (1.11–1.20)	< 0.0001^a
n	351	279
Median (min-max)	9 (1–88)	4 (1–45)
Use of parenteral nutrition	n (%)	n (%)		< 0.0001^b
No	117 (27.4%)	484 (68.7%)	1.0
Yes	310 (72.6%)	221 (31.3%)	5.88 (4.54–7.69)	< 0.0001^a
Parenteral nutrition time (days)			1.08 (1.05–1.12)	0.0008^a
n	310	221
Median (min-max)	6 (1–59)	6 (1–27)
Use of central catheter	n (%)	n (%)		< 0.0001^b
No	21 (4.9%)	246 (34.9%)	1.0
Yes	406 (95.1%)	459 (65.1%)	10.00 (6.66–16.66)	< 0.0001^a
Central catheter period (days)			1.09 (1.07–1.11)	< 0.0001^a
n	406	459
Median (min-max)	10 (1–93)	7 (1–34)
Number of catheters			3.93 (3.02–5.12)	< 0.0001^a
n	406	459
Median (min-max)	2 (1–5)	1 (1–3)
Surgery	n (%)	n (%)		< 0.0001^b
No	386 (90.4%)	687 (97.4%)	1.0
Yes	41 (9.6%)	18 (2.6%)	4.00 (2.27–7.14)	< 0.0001^a
Hospitalization period (days)			1.06 (1.05–1.07)	< 0.0001^a
n	427	705
Median (min-max)	50 (3–198)	14 (2–100)
Death	n (%)	n (%)		< 0.0001^b
No	368 (86.2%)	690 (97.9%)	1.0
Yes	59 (13.8%)	15 (2.1%)	7.14 (4.16–12.50)	< 0.0001^a

Blood culture	Absolute frequency (n)	Relative frequency (%)
Gram-negative bacteria	26	48.1
Gram-positive bacteria	21	38.9
Fungi	7	13.0
Total	54	100.0

	Odds ratio (95%CI)	p
Premature < 30 weeks	5.62 (1.83–17.28)	0.003^a
Use of mechanical ventilation	1.84 (1.26–2.68)	0.001^b
Use of central catheter	2.48 (1.40–4.37)	0.002^b
Total length of stay	1.06 (1.05–1.07)	< 0.0001^a

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E-mail: revsp@usp.br

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[1] Correspondence: Hermano Alexandre Lima Rocha Rua Papi Júnior, 1.223 60430-230 Fortaleza, Ceará, Brasil Email: hermano@ufc.br