Nosocomial Infections in Very Low Birthweight Infants in Germany: Current Data from the National Surveillance System NEO-KISS

Abstract

Background:

Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insu­rance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants.

Patients and Methods:

We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients’ birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.

Results and Conclusion:

The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days. The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections.

Zusammenfassung

Hintergrund:

Frühgeborene mit einem Geburts­gewicht <1 500 g (VLBW – very low birthweight Neonaten) tragen ein hohes Risiko für nosoko­miale Infektionen (NI). Ab dem Jahr 2000 etab­lierten wir in Deutschland ein Surveillance System für VLBW Neonaten: NEO-KISS. Der Gemeinsame Bundesausschuss beschloss im Jahr 2005 VLBW Neonaten versorgende Abteilungen zur Teilnahme an NEO-KISS zu verpflichten. In der Folge hat sich NEO-KISS zu einem Deutschland-weiten Surveillance System für nosoko­miale Infektionen bei VLBW Neonaten entwickelt.

Patienten und Methoden:

In diesem Artikel stellen wir aktuelle NEO-KISS Daten dar, die zwischen 2007 und 2011 erhoben wurden. Berechnet wurden die Raten für Sepsis, Pneumonie und nekrotisierende Enterokolitis (NEC). Um Abteilungs-spezifische Infektionsraten besser beurteilen zu können, führen wir einen neuen Indikator ein: die Standardisierte Infektionsrate (SIR). Die SIR berücksichtigt die Risikostruktur der jeweiligen Abteilung (basierend auf dem Geburtsgewicht der Patienten) und beschreibt das Verhältnis von aufgetretenen zu erwarteten Infektionen.

Ergebnisse und Schlussfolgerung:

Im angegebenen ­Zei­traum sammelten wir Daten von 33 048 VLBW Neonaten. Die Inzidenzdichte der ZVK-assoziierten Sepsis betrug 8,6/1 000 ZVK Tage. Die Inzidenzdichte der Pneumonie war 0,6/1 000 Patiententage und der beatmungs-assoziierten Pneumonie 2,7 pro 1 000 Beatmungstage. Die Inzidenzdichte der NEC war 0,8/1 000 Patiententage. Die SIR-Werte der NEO-KISS Abteilungen weisen eine starke Variation auf. Die SIR ist ein ausgezeichnetes Mittel um Ausreißer bei NI zu identifizieren.

Key words

nosocomial infections - VLBW - surveillance - NICU

Schlüsselwörter

nosokomiale infektionen - frühgeborene - surveillance - krankenhausinfektion

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