Issue 6 – December 2018

In 1996, Vermont Oxford Network added a measure for bacterial sepsis and/or meningitis occurring 4 or more days after birth (“late onset infection”). The measure requires reporting whether a pathogen on a 30-item Bacterial Pathogens List(1) was recovered from a blood or cerebrospinal fluid culture. The list, created with input from infectious diseases and microbiology experts, and was designed to capture major neonatal pathogens. Common commensals and rare pathogens were not included to limit the burden of chart review and abstraction.

As part of an ongoing collaboration between VON and the Centers for Disease Control and Prevention (CDC), we compared the organisms on the VON Bacterial Pathogens list to organisms associated with neonatal intensive care unit central line-associated bloodstream infections (CLABSI) that were reported to the CDC’s National Healthcare Safety Network (NHSN), the nation’s most widely used healthcare-associated infection tracking system. Our goal was to ascertain which pathogens on the VON Bacterial Pathogens list were reported to NSHN.

The CLABSI included 114 unique bacteria. Of those, 32 were common commensals and were not on the VON list, and 1 could not be identified by the name reported. We collapsed the pathogen names to the genus level to match the VON Bacterial Pathogens and removed the commensals and unknown, leaving 35 pathogens. Of those, 18 were on the VON Bacterial Pathogens list, representing 3,557 infections out of 3,591 CLABSI (99.1%) reported to NHSN.

Seventeen pathogens were reported to NHSN but were not on the VON list. These 17 pathogens caused 34 CLABSIs, or <1% of all CLABSIs. As a result of this review, the Bacterial Pathogen list for infants born in 2018 was revised to include Pantoea and Morganella morganii, and to specify Streptococcus species that are true pathogens, not common commensals (2).

The VON Bacterial Pathogens list captured over 99% of the pathogen-associated CLABSI reported to NHSN by NICUs. This suggests that a relatively short list of microorganisms can efficiently classify NICU late-onset infections – but with the important proviso that not all late-onset bloodstream infections are related to catheters. In 2018, Vermont Oxford Network added Database items for centers to report the pathogens on the Bacterial Pathogens List that were found in blood and cerebrospinal fluid cultures, which will help us understand whether revisions in the pathogen list are indicated.

Before electronic health records, collecting data for quality improvement required hand abstraction. Today, automated microbiology systems and electronic health records have the potential to greatly facilitate data extraction and analysis. However, continuous reviews and revisions of pathogen lists, such as VON’s, are necessary. New pathogens continue to emerge, and genus and species names change over time, particularly as genomic analysis becomes more sophisticated and available.

1. Appendix B. Vermont Oxford Network Manual of Operations Part 2 – Release 21.0. Burlington, VT: Vermont Oxford Network, 2016. Available online at: https://public.vtoxford.org/wp-content/uploads/2016/08/Manual_of_Operations_Part2_v21.pdf. Accessed August 6, 2018.
2. Appendix B. Vermont Oxford Network Manual of Operations Part 2 – Release 22.0. Burlington, VT: Vermont Oxford Network, 2017. Available online at: https://public.vtoxford.org/wp-content/uploads/2017/04/Manual_of_Operations_Part2_v22-1.pdf. Accessed August 6, 2018.

This report is made possible by Vermont Oxford Network members who voluntarily contribute data in a global effort to improve the care of high-risk newborns. VON members can view center-specific data by logging on to Nightingale and benchmark against this NICU by the Numbers report.

Editor and Analyst: Erika Edwards, PhD, MPH