BMJ paediatrics open · 2026
Closed multilumen infusion system reduces CLABSI and antibiotic exposure in very preterm neonates.
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Dacquino Fabrizio Maria, Gotchac Julien, Le Cabec Eloïse, Pauquet Emilie, Gérard Rémy
Аннотация
BACKGROUND: Central line-associated bloodstream infections (CLABSIs) remain a major morbidity in preterm neonates despite infection prevention bundles. While a closed multilumen infusion system (CMLIS) previously demonstrated CLABSI reduction, validation across different clinical settings remains limited.
OBJECTIVE: To evaluate whether CMLIS implementation in a different neonatal intensive care unit (NICU) confirms reduced CLABSI incidence density and optimises antimicrobial stewardship.
METHODS: This retrospective study in a French tertiary NICU included preterm neonates (23+0 to 31+6 weeks’ gestation) admitted between January 2024 and October 2025. Using multivariable Poisson regression and propensity score matching (PSM), we compared infants managed with standard manifolds versus the CMLIS. The primary outcome was CLABSI incidence density per 1000 catheter-days (defined as a central catheter-associated positive blood culture with infection signs, treated with appropriate antibiotics for ≥5 days). Secondary outcomes included antibiotic days of therapy, mortality, late-onset sepsis, prematurity-related complications and NICU length of stay.
RESULTS: Among the 170 neonates included, CMLIS implementation was associated with a significant reduction in the primary outcome (adjusted incidence rate ratio (aIRR): 0.50; p=0.025). This protective effect was confirmed in the PSM cohort (IRR: 0.55; p=0.03). Regarding antimicrobial stewardship, total antibiotic consumption decreased by 41% (aIRR: 0.59; p=0.002) and vancomycin usage decreased by 39% (aIRR: 0.61; p=0.006). No significant differences were observed in other clinical outcomes or exploratory mortality.
CONCLUSIONS: CMLIS implementation was associated with lower CLABSI incidence density and reduced antibiotic exposure. These findings suggest CMLIS offers valuable incremental benefits when baseline hygiene bundles are optimised, though further prospective validation is warranted.
OBJECTIVE: To evaluate whether CMLIS implementation in a different neonatal intensive care unit (NICU) confirms reduced CLABSI incidence density and optimises antimicrobial stewardship.
METHODS: This retrospective study in a French tertiary NICU included preterm neonates (23+0 to 31+6 weeks’ gestation) admitted between January 2024 and October 2025. Using multivariable Poisson regression and propensity score matching (PSM), we compared infants managed with standard manifolds versus the CMLIS. The primary outcome was CLABSI incidence density per 1000 catheter-days (defined as a central catheter-associated positive blood culture with infection signs, treated with appropriate antibiotics for ≥5 days). Secondary outcomes included antibiotic days of therapy, mortality, late-onset sepsis, prematurity-related complications and NICU length of stay.
RESULTS: Among the 170 neonates included, CMLIS implementation was associated with a significant reduction in the primary outcome (adjusted incidence rate ratio (aIRR): 0.50; p=0.025). This protective effect was confirmed in the PSM cohort (IRR: 0.55; p=0.03). Regarding antimicrobial stewardship, total antibiotic consumption decreased by 41% (aIRR: 0.59; p=0.002) and vancomycin usage decreased by 39% (aIRR: 0.61; p=0.006). No significant differences were observed in other clinical outcomes or exploratory mortality.
CONCLUSIONS: CMLIS implementation was associated with lower CLABSI incidence density and reduced antibiotic exposure. These findings suggest CMLIS offers valuable incremental benefits when baseline hygiene bundles are optimised, though further prospective validation is warranted.