Factors associated with persistent blood stream infection in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Clinical Microbiology

Background:

• Bloodstream infections (BSIs) are a significant concern for infants in the neonatal intensive care unit (NICU).
• Identifying factors associated with persistent BSIs is crucial for optimizing treatment and diagnostic strategies.
• The utility of follow-up blood cultures (FUBCs) in managing neonatal BSIs requires further elucidation.

Purpose of the Study:

• To determine factors associated with persistent BSIs in NICU infants.
• To identify clinical and microbiological predictors of persistent BSI.
• To inform diagnostic stewardship regarding the appropriate use of FUBCs.

Main Methods:

• A single-center study was conducted involving 121 infants in a level IV NICU over five years.
• Clinical and microbiological data from infants with positive blood cultures were analyzed.
• Bivariate and multi-regression analyses were used to identify factors associated with persistent BSI, defined as the same organism growing >48 hours after the initial culture.

Main Results:

• Factors associated with persistent BSI included recovery of *Staphylococcus aureus* (OR=6.10), male sex (OR=3.31), and the presence of a central venous catheter (OR=3.73).
• BSI in the context of late-onset sepsis was also significantly associated with persistence (p<.001).
• No infants with early-onset sepsis or *Streptococcal* species BSI experienced persistent infection.

Conclusions:

• Patient and microbial characteristics in the NICU setting can guide diagnostic stewardship decisions.
• The findings highlight specific risk factors that may warrant closer monitoring or specific interventions.
• Understanding these factors can optimize the use of FUBCs, improving patient outcomes and resource allocation.