Prospective Surveillance of Nosocomial Infections in a Swiss NICU: Low Risk of Pneumonia on Nasal Continuous Positive Airway Pressure?

Background: This study assessed the rate of invasive nosocomial infections in very low birth weight (VLBW) ≤ 1,500 g infants in a Swiss university hospital neonatal intensive care unit (NICU). Device–association and devicerelated infection rates were prospectively evaluated. Patients and Methods: From October 1999 to September 2000, 76 hospitalized neonates with VLBW were included, plus 60 neonates > 1,500 g, who had received a central venous or umbilical catheter, or assisted ventilation. Nosocomial infections (sepsis, pneumonia, necrotizing enterocolitis [NEC]) were defined according to Centers for Disease Control (CDC) recommendations with slight modifications and their rates measured longitudinally. Results: Among VLBW neonates, 16 nosocomial infections for an overall infection rate of 6 per 1,000 patient days were found. Infants with infection were of lower birth weight, a greater proportion was male, received lipid infusions, and on average had a higher severity of illness (CRIB) score. Interestingly, the ventilator–associated pneumonia (VAP) rate (12.5/1,000 ventilator days) seemed significantly higher than the pneumonia rate during nasal continuous positive airway pressure (NCPAP) treatment (1.8/1,000 NCPAP days; p = 0.04). The sepsis rate associated with peripheral catheters almost equaled the central line–associated rate, although numbers for both device–related infections were small. Conclusion: Further studies are needed to confirm the observation that the NCPAP–associated pneumonia rate might be lower than the VAP rate in VLBW infants, as well as to confirm the second observation that the sepsis rates on peripheral catheters compared to central venous catheters might be almost equal in VLBW infants. Reducing the exposure to ventilation via endotracheal tube, but not using peripheral as opposed to central catheters, might reduce the incidence of device–associated infection in this patient population.