Introduction: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. Methods: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and in a case control approach, children with NI (cases) were compared with a matched controls without NI. Results: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. Conclusions: The incidence of NI acquired in this unit was high and was associated with extrinsic factors. Keywords: Nosocomial infections. Pediatric ICU. Surveillance system. RESUMO Introdução:O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns -sepse, pneumonia e infecção do trato urinário (ITU) -em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. Métodos: Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. Resultados: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. Conclusões: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos. Palavras-chaves: Infecções hospitalares. UTI pediátrica. Sistema de vigilância.Nosocomial infection (NI) constitutes a major health pro...

ObjectiveTo monitor occurrence trends and identify clusters of nosocomial infection (NI) using statistical process control (SPC) charts. MethodsBetween January 1998 and December 2000 nosocomial infection occurrence was evaluated in a cohort of 460 patients admitted to the Pediatric Intensive Care Unit of a university hospital, according to the concepts and criteria proposed by the National Nosocomial Infection Surveillance System of the Centers for Disease Control, in the United States. Graphs were plotted using Poisson statistical distribution, including three horizontal lines: center line (CL), upper warning limit (UWL) and upper control limit (UCL). CL was the arithmetic mean NI rate calculated for the studied period; UWL and Rev Saúde Pública 2003; 37(6) Endemic nosocomial infection graphs www.fsp.usp.br/rsp Arantes A et al UCL were drawn at 2 and 3 standard deviations above average NI rates, respectively. Clusters were identified when NI rates remained above UCL. ResultsMean NI incidence was 20 per 1,000 patient days. One urinary tract infection cluster was identified in July 2000, with an infection rate of 63 per 1,000 patient days, exceeding UCL and characterizing a period of epidemic. ConclusionsThe use of SPC charts for controlling endemic levels of NI, through both global and site-specific evaluation, allowed for the identification of uncommon variations in NI rates, such as outbreaks and epidemics, and for their distinction from the natural variations observed in NI occurrence rates, without the need for calculations and hypothesis testing.

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We studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.

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