Evolving patterns of healthcare-associated infections in NICU: a five-year retrospective analysis from a tertiary children's hospital in China.

Background: Neonates in the NICU, particularly those born with very low birth weights, are at heightened risk for healthcare-associated infections (HAIs). Such infections can prolong hospitalization, increase medical costs, and potentially lead to adverse long-term outcomes. Recognizing evolving infection patterns and targeted prevention measures is essential to improving patient care.

Methods: We retrospectively collected data on neonates admitted to the NICU of our hospital between January 2019 and December 2023. Information regarding HAI incidence, site of infection, device utilization, pathogen distribution, and antibiotic use was extracted and statistically analyzed. Comparisons regarding infection rates and clinical variables were performed using chi-square or Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.

Results: Among 9786 neonates (70,509 patient-days), 86 HAI cases were identified (0.88%), corresponding to 1.22‰ infections per 1000 patient-days. Neonates with extremely low birth weight had significantly higher infection rates (13.04%) than other birth weight groups (p < 0.01). Bloodstream infections (35.87%) were the most common site, followed by respiratory and gastrointestinal infections (both 18.48%). Central line-associated bloodstream infection occurred at 0.75 infections per 1000 catheter-days, while ventilator-associated pneumonia decreased from 2.76‰ to 0.73‰ over the study period. Staphylococcus epidermidis was the predominant isolate among the pathogens identified. Neonates with HAIs had significantly longer antibiotic courses and higher rates of combination antibiotic therapy (p < 0.001).

Conclusions: Although the overall incidence of NICU HAIs declined from 2019 to 2023, infection patterns continued to evolve, particularly regarding bloodstream infections. Prevention strategies must focus on high-risk neonates, rigorous device management, punctual surveillance of pathogen resistance, and prudent antibiotic use to further reduce infection morbidity and mortality in the NICU setting.