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

Abstract

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...

Global Assessment of Antimicrobial Susceptibility among Gram-Negative Organisms Collected from Pediatric Patients between 2004 and 2012: Results from the Tigecycline Evaluation and Surveillance Trial

“…Henderson et al showed that Gram-positive pathogens were considerably more common among pediatric patients with bacteremia in England and Wales, with the most common Gram-negative pathogens being E. coli and Neisseria meningitidis, which accounted for only 5% of infections each (11). In a pediatric intensive care unit (ICU) in Brazil, however, Gram-negative pathogens accounted for the largest proportion of infections (47%) among cases of sepsis, pneumonia, and urinary tract infections, with E. coli and Enterococcus faecalis being the most common pathogens encountered (18% each) (12). An even more dramatic difference was observed among nosocomial infections (NIs) in a general pediatric hospital in Turkey, where Gram-negative pathogens accounted for 79.8% of cultured pathogens among 229 NIs; the most common pathogens identified were Klebsiella spp.…”

Gram-negative infections in pediatric and neonatal intensive care units of Latin America

“…Full-text articles were retrieved for 46 abstracts and further reviewed for eligibility by both authors, after which 12 articles met our inclusion criteria and were appropriate for in-depth assessment (Table 1) . These were 11 observational and one case-control study citations describing acquired infection and mortality rates, as well as epidemiology of Gramnegative infections, in Latin American PICUs and NICUs [9][10][11][12][13][14][15][16][17][18][19][20]. The studies varied widely with respect to location, time period, patient population, design, and data reporting, which prevented inter-study comparisons.…”

“…Eight of the 12 studies reported data regarding acquired infection and mortality rates ( Table 2) [9][10][11]14,[16][17][18][19]. The infection rate (35% to 37% vs ≤ 24%) and incidence rate (58% vs ≤ 20%) was highest in studies enrolling significant proportions of extremely low-birth-weight infants, as evidenced by data from a 10-year prospective follow-up study and a 3-year retrospective study, both of which were conducted in Brazil [10,19].…”

Patterns of antimicrobial resistance in a pediatric cardiac intensive care unit

“…Результаты других аналогичных исследований указывают на респираторные инфекции и инфекции уретрального трака [15][16].…”