Facility Factors Associated With Candida Central Line–Associated Bloodstream Infections in Neonatal Intensive Care Units

BACKGROUND Candida species are a leading cause of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with high associated morbidity and mortality. Data about facility-level factors associated with Candida CLABSI incidence in NICUs are lacking. METHODS We analyzed Candida CLABSIs reported through the Centers for Disease Control and Prevention’s National Healthcare Surveillance Network (NHSN) bloodstream infection module and assessed facility characteristics using NHSN and American Hospital Association annual surveys during 2015-2022. We assessed annual Candida CLABSI incidence/1000 central line days and fit negative binomial models to assess associations of hospital and NICU characteristics with CLABSI incidence, controlling for birthweight category and year. RESULTS Among 862 NICUs, facilities with lower nurse-to-bed ratios (incidence rate ratio IRR = 1.33; 95% CI, 1.03–1.70) and fewer infection preventionist surveillance hours/bed (IRR = 1.33; 95% CI, 1.05–1.70) had increased Candida CLABSI incidence. Incidence was also higher in the NICUs in the lowest tertile of NICU bed size (IRR = 1.90; 95% CI, 1.42–2.53), annual neonatal admissions (IRR = 1.87; 95% CI, 1.21–2.79), and percentage of very low birthweight admissions (IRR = 2.12; 95% CI, 1.45–3.05) compared with NICUs in the highest tertile of each variable. CONCLUSION Higher Candida CLABSI rates were observed at smaller NICUs and those with lower staffing ratios, possibly reflecting lower capacity for infection prevention and control and care for neonates who are at high-risk for CLABSIs. These data may inform facility-focused or systems-level interventions to reduce Candida CLABSIs and protect vulnerable neonates.