Epidemiology of bacterial and fungal infections among level IV neonatal units in North America.

BACKGROUND

Neonatal infections cause significant morbidity and mortality. A comprehensive analysis of bloodstream infections (BSI), urinary tract infections (UTI) and meningitis across level IV neonatal intensive care units (NICUs) is lacking.

METHODS

This retrospective cohort study utilized data from the Children's Hospitals Neonatal Database (CHND) between January 2011 to December 2022. Patients with positive blood, urine, and cerebrospinal fluid (CSF) cultures were assessed. BSI trends across five geographic zones and a 10-year trend were studied.

RESULTS

Of 172,921 patients, 15,541 (9.0%) had a culture-positive BSI, UTI, and/or meningitis. Within the 18,281 positive cultures (9794 BSI, 7097 UTI and 1390 CSF), 21,919 pathogens were identified. Infection rates were inversely related to gestational age. Pathogen distribution varied across regions, and over 10 years, Coagulase negative Staphylococcus declined, while E. coli and S. aureus proportions increased.

CONCLUSION

Understanding infection trends in level IV NICUs can inform targeted preventive strategies and quality improvement initiatives.