Investigation of healthcare associated infections in Newborn İntensive Care Units of Cukurova University Faculty of Medicine, Balcali Hospital

Aim: In this study, we aimed to determine the incidence of healthcare-associated infections (HAI) in the first 28 days of life, maternal and infant risk factors, the distribution of microorganisms grown in sterile fluids, and antibiotic resistance profiles in the Newborn Intensive Care Units of Çukurova University Faculty of Medicine Balcalı Hospital. Material and Methods: The study was carried out prospectively recording the patient files and daily observation data of all newborns who were hospitalized in the unit longer than 72 hours between 01.01.2021 and 31.12.2021. Risk factors, culture results and resistance patterns of microorganisms in HAIs were investigated. Findings: During the study, 395 of 641 newborns were hospitalized in the Neonatal Intensive Care Unit for more than 72 hours. Of the patients, 209 (% 52,9) were male and 186 (% 47,1) were female. The mean age at admission was 2.59±7.22 days. 99 episodes of HAIs were detected in 78 (% 19,7) patients. Proven sepsis was reported in 44 (11.1%) patients (63 attacks), and clinical sepsis was reported in 36 (9.1%) patients including two patients who had both proven and clinical sepsis. The most common infection in patients with proven sepsis was bloodstream infection (BSI) (n: 29, % 46), followed by ventilator-associated pneumonia (VAP) (n: 27, 42.8%) and urinary tract infection (n: 6, 9.5%). Gram positive microorganisms were dominant (70%) in BSIs, and Gram negative microroganisms were dominant (66.7%) in VAP. When the proven sepsis group was compared with other patient and the clinical sepsis group was compared with non-infected infants; the mean birth weight, week of gestation, 1st and 5th minute Apgar scores were significantly lower. Antenatal steroid exposure, catheter use, ventilator use, transfusion need, length of stay, mortality and morbidity rate, and mortality rate secondary to infection were higher (p<0.001). Necrotizing enterocolitis, patent ductus arteriosus, and retinopathy of prematurity were more common in the proven sepsis group (p<0.001). In patients with proven and clinical sepsis, the risk of sepsis increased as birth weight decreased (p<0.001; p=0.004). When the risk factors of proven and clinical sepsis patients are evaluated together, the use of antibiotics (ampicillin and gentamicin) in the first week increased the risk of sepsis for 4.76 times. It was observed that the feeding mainly with breast milk two days before the development of sepsis also reduced the risk of sepsis for 12.5 times. The orogastric feeding increased the risk of sepsis for 4.68 times; one per day increase in parenteral nutrition use for 1.17 times; each day increase in hospital stay for 1.16 times; the presence of umblical catheter for 5.76 times, and the presence of PDA increased the risk for 7.57 times. Considering these measurements, the diagnosis of sepsis could be determined with a total accuracy of 92.4%. The specificity was 95.9% and the sensitivity was 78.2%. Conclusion: Healthcare-associated infections are a major problem in the NICU. Active surveillance should be carried out in every NICU and, HAIs and risk factors should be identified; effective steps should be taken for prevention. Keywords: Newborn, Intensive Care, Healthcare, Infection, Sepsis, Risk Factor