Active Surveillance for Central Line Associated Bloodstream Infections in Hospitalized Neonates in Greece

K. Mougkou, N. Anagnostatou, L. Baglatzi, M. Dilanas, D. Gkentzi, I. Grivea, K. Kaffe, K. Karachristou, A. Kontogianni, L. Lianou, A. Mpilali, C. Petropoulou, Z. Stratiki, I. Zorou, J. Kopsidas, G. Kourlaba, S. Coffin, T. Zaoutis; Athens, Heraklion, Patras and Larissa (Greece), and Philadelphia (PA, USA)
4th International Congress of Union of European Neonatal and Perinatal Societies (UENPS)
December 11th-14th, 2014, Athens, Greece

BACKGROUND AND AIM: Central Line Associated Bloodstream Infection (CLABSI) is one the most common healthcare-associated infections in hospitalized neonates and is associated with significant mortality, increased length of hospital stay and increased healthcare costs. Since there are limited data about neonatal CLABSI, our aim was to prospectively assess the epidemiology of CLABSIs in 10 Neonatal Intensive Care Units (NICUs) in Greece.

METHODS: A 22-month prospective surveillance study was conducted in 10 NICUs, including both public and private, as well as pediatric and adult hospitals in Greece. CLABSIs were prospectively identified using the National Healthcare Safety Network definition [1]. Data, including central line and patient days, were collected daily by volunteers in each unit. CLABSI rates (per 1,000 central line-days) and device utilization (DU) ratios (total number of device-days divided by the total number of patient-days) were calculated. Epidemiological and clinical data of the children who developed CLABSI were recorded.

RESULTS: During the 22-month surveillance period, we detected 38 CLABSIs in 34 patients. The overall CLABSI rate was 3.80/1,000 central-line days. Unit specific CLABSI rates ranged from 0 to 15.7 per catheter days. Overall DU ratio was found to be 0.17 (DU range 0.008 to 0.39).

The main patient-related and infection-related characteristics are described in Tab. 1. Median patient age was 31.5 days (interquartile range, 10-97 days).

CONCLUSIONS: We found high CLABSI rates in 6 of the NICUs compared to rates reported in the United States and European Union, while rates in the other units were comparable. Infection control efforts should be developed and focused on units with high CLABSI rates.

Table 1. The main patient-related and infection-related characteristics.

Characteristics of neonates with CLABSI (n = 34)
Gender (Male)   18 (52.9%)
Age (days)   31.5 (10-97)
Transfer from another hospital   24 (70.6%)
Characteristics of CLABSIs (n = 38)  

Hospitalization within past 30 days prior to


  29 (78.4%)
Type of central catheter  
Tunneled   18 (47.4%)
Non tunneled   4 (10.5%)
Umbilical   10 (26.3%)
Peripherally Inserted Central Catheter (PICC)   5 (13.2%)
Blood transfusion within 1 week (Yes)   16 (42.1%)
Surgical procedure within 30 days (Yes)   9 (23.7%)
Mechanical ventilation at time of CLABSI   12 (31.6%)
Urinary catheter at time of CLABSI   4 (10.8%)
Immunosuppressive agents within 30 days   1 (2.6%)
Fever   29 (76.3%)
Removal of catheter as adjunctive treatment  
No central catheter present at infection onset   1 (2.6%)
Central catheter removed as part of treatment   15 (39.5%)
Central catheter left in place during treatment   22 (57.9%)


[1] Centers for Disease Control and Prevention,