Factors associated with persistent blood stream infection in the Neonatal Intensive Care Unit

Objective: This study determined factors associated with persistent blood stream infections (BSIs) for infants in the NICU to identify when follow up blood cultures (FUBCs) have increased utility. Study design: Single center study of all infants in a level IV NICU (n=121) with a positive blood culture over a five-year period. Clinical and microbiological variables were examined with bivariate and multi-regression analyses to identify factors associated with persistent BSI, defined as growth of the same organism >48 hours after the index culture. Results: The recovery of Staphylococcus aureus (OR=6.10, p<.001), male sex (OR=3.31, p=.020), the presence of a central venous catheter (OR=3.73, p=.020), and BSI in the setting of late-onset sepsis (p<.001) were associated with persistent BSI. No infants with either early-onset sepsis or growth of Streptococcal sp. had a persistent BSI. Conclusion: In the NICU, both patient and microbial characteristics can inform diagnostic stewardship regarding the need for FUBCs.