Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study

Abstract

Introduction: Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the NICU of the Uberlândia University Hospital. Methods‫׃‬ Data were collected through the National Healthcare Safety Network surveillance from January 2006 to December 2009. The patients were followed five times/week from their birth to their discharge or death. Results‫׃‬ The study included 1,443 patients, 209 of these developed NIs, totaling 293 NI episodes, principally bloodstream infections (203; 69.3%) and conjunctivitis (52; 17.7%). Device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonias per 1000 ventilator-days. The mortality rate in neonates with NI was 11.9%. Mechanical ventilation, total parenteral nutrition, orogastric tube, previous antibiotic therapy, use of CVC and birth weight of 751-1,000g appeared to be associated with a significantly higher risk of NI (p ≤ 0.05). In multiple logistic regression analysis for NI, mechanical ventilation and the use of CVC were independent risk factors (p ≤ 0.05). Coagulase-negative Staphylococcus (CoNS) (36.5%) and Staphylococcus aureus (23.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and S. aureus were 81.8% and 25.3%, respectively. Conclusions‫׃‬ Frequent surveillance was very important to evaluate the association of these well-known risk factors with NIs and causative organisms, assisting in drawing the attention of health care professionals to this potent cause of morbidity.

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

“…The VLBW infants using parenteral nutrition, who are strongly exposed to the NICU environment, to the colonization of the non-inserted distal catheter tip due to handling by the health team professionals and contact with the microbiota of their own skin, represent important risk factors, as mentioned in different studies that observed high rates of blood infections associated with central venous catheters. (4,8,13,(17)(18)(19) In this study, the arterial umbilical catheter was 8.5 times more associated with the occurrence of late sepsis, in line with other association studies between hospital infections and venous catheters. (17,19) The blood infections related to the use of venous catheter are reported to be the most common at the NICU, and mostly result from technical errors in the installation and care for the insertion site and in catheter handling.…”

“…(4,8,13,(17)(18)(19) In this study, the arterial umbilical catheter was 8.5 times more associated with the occurrence of late sepsis, in line with other association studies between hospital infections and venous catheters. (17,19) The blood infections related to the use of venous catheter are reported to be the most common at the NICU, and mostly result from technical errors in the installation and care for the insertion site and in catheter handling. (20) The occurrence of late neonatal sepsis and its relation with the NICU environment and the invasive procedures the infants are submitted to have been widely discussed in studies undertaken in the large urban centers of Brazil and internationally.…”

“…Birth weight is a strong factor associated with the risk of sepsis in preterm infants due to the peculiar immunological immunity, being inversely proportional. (4,7,16,19) In this study, a strong association and greater risk for sepsis were found.…”

“…(20) The occurrence of late neonatal sepsis and its relation with the NICU environment and the invasive procedures the infants are submitted to have been widely discussed in studies undertaken in the large urban centers of Brazil and internationally. (5,7,8,17,19,21) This concern targets improvements in the quality of care for low-weight infants, reducing the sequelae of clinical problems provoked by intense infection processes and death rates.…”

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

“…The length of stay in our PICU was found to be the risk factor for NI by unvaried analyses, similar to other studies, and long stay reflects the severity of the underlying disease, requiring greater care 6,23 . No differences were found in the distribution of pathogens in PICU infections when compared with those observed in adults 19,24,25 . Gram-negative bacilli were predominant (47%), followed by Grampositive cocci (44.1%) and yeasts (8.9%).…”