Abstract: Objective To investigate the rate of central lines (CLs) placement, the incidence and pathogen distribution of central line-associated bloodstream infection (CLABSI) in 25 neonatal intensive care units (NICU) in China.Methods This study used data from a standardized database initially established for a cluster randomized controlled study "Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality (REIN-EPIQ)". All preterm infants with gestational age <34 weeks and admitted to 25 tertiary NICUs in China from May 2015 to April 2018 were enrolled in the study. Infants who did not receive active care and discharged against medical advice were excluded.Results A total of 24,884 preterm infants were enrolled. CLs were placed among 9,537 (38.3%) infants and PICC were placed among 7,532 (79.0%) infants. The overall incidence of CLABSI was 2.4/1,000 catheter days. CLABSI-related fatality rate was 6.7%(35/526). The incidence of CLABSI increased with decreasing gestational age. There was a remarkable variation of the incidences of CLABSI among 25 participating NICUs, ranging from 0.0-9.8/1,000 catheter days. The predominant pathogen of CLABSI were gram-negative bacteria (46.2%), followed by gram-positive bacteria (33.9%) and fungi (19.9%).Conclusion CLs were increasingly used in Chinese NICUs with incidence of CLABSI varying significantly among different NICUs. Gram-negative bacteria were the predominant pathogen causing CLABSI and the proportion of CLABSI caused by fungi was alarming high. Targeted quality improvement projects are needed to reduce the site variation and fungi infection.

Key words: Central line-related bloodstream infection, Central lines, Pathogen, Peripherally inserted central venous catheter, Preterm infants, Umbilical venous catheter