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Published on: January 27, 2019
Protocol for a prospective cohort study: Prevention of Transmissions by Effective Colonisation Tracking in Neonates
Tim Götting1, Sandra Reuter2, Daniel Jonas2
1Institute for Infection Prevention and Hospital Epidemiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany tim.goetting@uniklinik-freiburg.de.
Insights
This study tracks bacterial transmissions in neonatal intensive care units (NICUs) to identify risk factors for infant infections. Understanding these transmission dynamics is crucial for preventing serious health outcomes in vulnerable newborns.
Area of Science:
- Neonatalogy
- Infectious Disease Epidemiology
- Genomic Epidemiology
Background:
- Opportunistic bacterial pathogens pose significant risks to neonates in intensive care settings, leading to severe infections.
- Patient and ward-related factors influencing transmission probability are not well-defined, hindering effective prevention strategies.
Purpose of the Study:
- To quantify transmission event density in a level III neonatal intensive care unit (NICU).
- To identify intrinsic and extrinsic risk factors associated with bacterial transmissions among neonates.
Main Methods:
- Prospective cohort study of all patients in a 17-bed level III NICU over 1 year.
- Identification of transmission events through whole-genome sequencing of isogenic bacterial isolates from different patients.
- Collection of intrinsic (patient) and extrinsic (ward) risk factor data.
Main Results:
- Study is ongoing, with data collection and analysis underway.
- Hypothesizes increased transmission density during periods of high ICU demand.
- Will utilize Poisson logistic regression, proportional hazard, and multilevel competing risk models.
Conclusions:
- Findings will elucidate transmission patterns of opportunistic pathogens in NICUs.
- Identification of risk factors will inform targeted interventions to reduce neonatal infections.
- Results aim to improve patient safety and outcomes in high-risk neonatal populations.
Introduction:
Transmissions of opportunistic bacterial pathogens between neonates increase the risk of infections with negative repercussions, including higher mortality, morbidity and permanent disabilities. The probability of transmissions between patients is contingent on a set of intrinsic (patient-related) and extrinsic (ward-related) risk factors that are not clearly quantified. It is the dual objective of the Prevention of Transmissions by Effective Colonisation Tracking-Neo study to determine the density of transmission events in a level III neonatal intensive care unit (NICU) and to identify risk factors that may be causally associated with transmission events.
Methods And Analysis:
A full cohort of patients treated in a 17-bed level III NICU will be prospectively followed and transmission events between two or more patients will be documented. A transmission event occurs when isogenic isolates from two different patients can be identified. Isolates will be obtained by routine weekly screening. Isogenicity will be determined by whole-genome sequencing. During the study, relevant intrinsic and extrinsic risk factors will be recorded. Specimen and data will be collected for 1 year. We postulate that transmission density increases during episodes when demand for intensive care cannot be met by existing staff, and that threshold dynamics have a bearing on cohorting and hand hygiene performance. Poisson logistic regression, proportional hazard and multilevel competing risk models will be used to estimate the effect of explanatory variables.
Ethics And Dissemination:
This study has been approved by the local ethics committee (study ID 287/18). The results will be published in peer-reviewed medical journals, communicated to participants, the general public and all relevant stakeholders.
Trial Registration Number:
The German Clinical Trials Registry (DRKS00017733); Pre-results.
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