Evidence map›Paper›PMID 40131271›Full record

ArticleJAMA network open2025

Risk Factors for Health Care-Associated Bloodstream Infections in NICUs.

Julia Johnson, Sudhir Malwade, Sharad Agarkhedkar, Bharat Randive, Uday C Rajput, Chhaya Valvi, Aarti Kinikar, Tushar B Parikh, Umesh Vaidya, Abhay Kadam and 10 more

Abstract readMulticenter Study
In one paragraph

Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Inter-specialty differences in the management of febrile neonates on prostaglandin E1.Journal of perinatology : official journal of the California Perinatal Association · 2026
    Article
  5. Article
  6. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Julia JohnsonDivision of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sudhir MalwadeDepartment of Pediatrics, Dr. D. Y. Patil Medical College, Pune, India.
Sharad AgarkhedkarDepartment of Pediatrics, Dr. D. Y. Patil Medical College, Pune, India.
Bharat RandiveJohns Hopkins India, Pune, India.
Uday C RajputDepartment of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Chhaya ValviDepartment of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Aarti KinikarDepartment of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Tushar B ParikhDivision of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India.
Umesh VaidyaDivision of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India.
Abhay KadamJohns Hopkins India, Pune, India.
Basma OuddiDivision of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Rachel M SmithCenters for Disease Control and Prevention, Atlanta, Georgia.
Matthew WestercampCenters for Disease Control and Prevention, Atlanta, Georgia.
Vidya MaveJohns Hopkins India, Pune, India.
Christina SchumacherCenter for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Susan E CoffinDivision of Infectious Diseases, Department of Pediatrics, University of Pennsylvania, Philadelphia.
Matthew L RobinsonDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Amita GuptaDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Yukari C ManabeDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Aaron M MilstoneDivision of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Funding

Leadership and Operations Center (LOC), AIDS Clinical Trials Group (ACTG); LOC 1/UM1AI068636 · NIAID · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Joseph J Eron, RAJESH T GANDHI · 2011 to 2026
$1073.1M
LOC-IMPAACT Leadership GroupPharmacokinetics and Safety of Remdesivir for Treatment of COVID-19 in Pregnant Women in the USUM1AI068632 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI Jennifer Jao, Sharon A Nachman · 2011 to 2026
$278.1M
Antibacterial Resistance Leadership Group (ARLG)UM1AI104681 · NIAID · DUKE UNIVERSITY · PI Vance G. Fowler, Henry F HENRY CHAMBERS · 2013 to 2026
$180.8M
The Johns Hopkins Baltimore-Washington-India Clinical Trials Unit (BWI CTU)UM1AI069465 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Charles W. Flexner, Amita Gupta · 2012 to 2026
$34.1M
TB AftermathR01AI143748 · NIAID · JOHNS HOPKINS UNIVERSITY · PI GOLUB, JONATHAN E., MAVE, VIDYA · 2020 to 2025
$3.1M
Mentoring in prevention of hospital-acquired infections and antibiotic resistanceK24AI141580 · NIAID · JOHNS HOPKINS UNIVERSITY · PI AARON M MILSTONE · 2019 to 2026
$1.4M
Preventing antimicrobial resistance and infections in hospitalized neonates in low resource settingsK23HD100594 · NICHD · JOHNS HOPKINS UNIVERSITY · PI JOHNSON, JULIA · 2020 to 2024
$857k
NIAID NIH HHS K24 AI141580NIAID NIH HHS R01 AI143748NIAID NIH HHS UM1 AI068632NIAID NIH HHS UM1 AI068636NIAID NIH HHS UM1 AI069465NIAID NIH HHS UM1 AI104681NICHD NIH HHS K23 HD100594
6 · The paper itself

Abstract

Importance: Neonates requiring intensive care are at high risk of health care-associated infections. In neonatal intensive care units (NICUs) in low-resource settings, the identification of modifiable risk factors can inform targeted prevention strategies to reduce the global burden of neonatal morbidity and mortality. Objective: To describe the incidence of and the risk factors associated with health care-associated bloodstream infections (BSIs) in NICUs in Pune, India. Design, Setting, and Participants: This multicenter prospective cohort study enrolled all neonates admitted to 3 NICUs in Pune, India, from May 1, 2017, to July 31, 2019. Neonates were followed up from admission until discharge, transfer, or death. This secondary data analysis included neonates admitted for 3 days or more and was completed on January 31, 2024. Main Outcomes and Measures: The primary outcome was health care-associated BSIs, defined as a positive blood culture on or after admission day 3. Summary statistics, incidence of health care-associated BSIs, and hazard rate by characteristics of interest were generated. Among neonates admitted for 7 days or longer, the association between antibiotic exposure and infection risk was assessed. Results: A total of 6410 neonates were admitted for 3 days or longer. The median gestational age was 34 weeks (IQR, 32-37 weeks), and 3560 (55.5%) were male. The incidence of health care-associated BSIs was 6.09 per 1000 patient-days. Most isolates were gram-negative organisms (n = 273 [66.3%]), of which 85.5% (202 of 236 isolates tested) were resistant to third- or fourth-generation cephalosporins and 44.8% (117 of 261 isolates tested) were resistant to carbapenems. The hazard rate of health care-associated BSIs was higher among neonates with central venous catheters, respiratory support, or urinary catheters within 3 days preceding infection. Of 3229 neonates admitted for 7 days or longer, 190 (5.8%) had health care-associated BSIs on or after hospital day 7, with an incidence of 3.22 per 1000 patient-days. Antibiotic exposure during the first week of admission was associated with a nearly 3-fold increase in the risk of health care-associated BSIs (adjusted hazard ratio, 2.82 [95% CI, 1.26-6.32]). Conclusions and Relevance: In this cohort study of 6410 neonates admitted to 3 NICUs in Pune, India, the risk of health care-associated BSIs was associated with the presence of indwelling devices and prior antibiotic exposure. Future efforts should focus on mitigating the risks associated with indwelling devices and strengthening infection prevention and control and antimicrobial stewardship programs to prevent health care-associated infections.

Indexed as

BacteremiaCross InfectionIntensive Care Units, NeonatalAnti-Bacterial AgentsFemaleHumansIncidenceIndiaInfant, NewbornMaleProspective StudiesRisk FactorsAnti-Bacterial Agents

Identifiers

PMID40131271
PMCPMC11937935

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.