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Background and Objectives: Nosocomial infections in NICUs tend to cluster, sometimes as devastating outbreaks, but pathogen-specific transmission probabilities are unknown. We aimed to quantify the pathogen-specific risk of a blood stream infection (BSI) in preterm infants after an index case with that pathogen in the same department., Methods: Data of 44 818 infants below 1500 g birth weight of the German NICU surveillance system (2000-2011) were used to calculate the probability of a BSI in the presence or absence of another infant in the same unit with a same-pathogen BSI., Results: The relative risk was similar for the more common pathogens, Enterococcus spp (4.3; 95% confidence interval: 2.7-6.9; n = 243), Enterobacter spp (7.9, 5.4-11.4; n = 246), Escherichia coli (7.9; 5.1-12.1; n = 210), Candida albicans (8.7; 5.0-15.4; n = 138), Staphylococcus aureus (9.5; 7.6-12.1; n = 407) and Klebsiella spp (13.1; 9.0-19.1; n = 190) but markedly elevated for Serratia spp (77.5; 41.1-146.1; n = 58) and Pseudomonas aeruginosa (64.5; 25.7-162.1; n = 38). Rates of BSI per 100 exposed infants ranged between 2.21 (Enterococcus) and 8.15 (Serratia). The same pattern emerged after adjustments were made for patients' characteristics or when the analysis was restricted to positive blood cultures during the preceding 30 days., Conclusions: Although BSIs with P aeruginosa or Serratia spp in preterm infants are rare, they are associated with a markedly elevated risk of secondary same-pathogen BSI and should prompt intensified active surveillance and infection control measures., (Copyright © 2016 by the American Academy of Pediatrics.)

Background: We evaluated the mortality due to nosocomial bloodstream infection (BSI) and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants in 229 neonatal departments participating in the German national neonatal infection surveillance system between 2000 and 2011., Methods: For each infection type, we conducted a retrospective cohort study and a case-control study. In the cohort studies, the mortality risk due to BSI and/or NEC was estimated by calculating adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) using Cox proportional hazard regression with time the dependent variable infection. In the matched case-control studies, the attributable mortality was calculated., Results: A total of 43,116 VLBW infants, of which 6911 patients had at least 1 BSI and 1271 patients had at least 1 NEC, were analyzed. Overall mortality was 6.6%. Patients with at least 1 BSI had a mortality of 5.6%, and patients with at least 1 NEC had a mortality of 19.2%. The cohort studies revealed that BSI (AHR=1.83; 95% CI: 1.61-2.08) and NEC (AHR=6.35; 95% CI: 5.47-7.37) are independently associated with increased mortality. In the case-control study for BSI, 5187 (75.1%) patients with BSI were matched. Attributable mortality was 1.4% (95% CI: 0.7-2.2). In the case-control study for NEC, 1092 (85.9%) patients with NEC were matched. Attributable mortality was 14.7% (95% CI: 12.2-17.1)., Conclusions: Nosocomial BSI and NEC increased mortality in VLBW infants. BSI, however, was associated with a relatively small attributable mortality of 1.4%, whereas NEC had a high attributable mortality of 14.7%.

Objectives: This study aimed to determine the prevalence of and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and methicillin-resistant Staphylococcus aureus (MRSA) in very low birth weight (VLBW; <1500 g) infants and their mothers., Methods: This investigation was conducted in the perinatal centre at the Charité Berlin between May 2012 and June 2013. VLBW infants and their mothers were screened for colonization with ESBL-E and MRSA. Demographic and clinical data were obtained from the German nationwide surveillance system for nosocomial infections in VLBW infants (NEO-KISS) and used to perform univariate and multivariate analyses., Results: Of 209 VLBW infants, 12 (5.7%) were colonized with ESBL-E. Eighteen of 209 (8.6%) ESBL-E-tested neonates were related to an ESBL-E-positive mother. Univariate analysis, strain typing and multivariate analysis (OR 7.4, 95% CI 2.1-26.7, P = 0.002) identified an ESBL-E-positive mother and maternal-neonatal transmission as a main source of colonization. The prevalence of MRSA was 2.3% (5 of 221) among VLBW infants. One of the 221 (0.5%) MRSA-tested neonates was related to an MRSA-positive mother. No risk factors for transmission of MRSA could be detected in this study., Conclusions: Our study demonstrated that maternal-neonatal transmission of ESBL-E from mother to child is an important risk factor for colonization of VLBW infants. As a consequence, routine ESBL-E screening of neonates and mothers should be considered as a means of reducing neonatal morbidity and mortality., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

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.The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days., Results and Conclusion: 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., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: NEO-KISS is a national surveillance system generating reference data for nosocomial infections among very low birth weight infants (VLBW) and was established 2000 as a voluntary based system. Since 2006 exist an official decision that participation in NEO-KISS is a prerequisite for the care of VLBW at level III NICUs in Germany., Method: Comparing the reference data before and after the resolution and analysing the structure and the infection rates between the departments participating since 2006 (new-departments) and the neonatology departments participating voluntary before 2006 (old-departments)., Results: Since 2006 the number of participating departments increased clarion. The characteristic of the 110 new-departments differs from the 46 old-departments in many ways. The old-departments treated more VLBW per month, have more beds and are located at larger hospitals. The distribution of the treated VLBW shows a trend to lower birth-weights in the old-departments. However, the comparison of the reference data 2005, generated only from data from old-departments, shows no systematic changes to the reference data 2006 (including data from numerous new-departments). Also the comparison of the infection rates from for an identical time period separated for new and old-departments shows only minor differences., Conclusion: The inclusion of many new departments in NEO-KISS shows no influence to the reference data. And also the comparison of infection rates between new and old-departments shows no systematic discrepancy. It follows the unnecessary of separating the data from old-departments and new-departments and the appropriateness of the entire databank to generate the national reference data.