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Pediatric, neonatal intensive care units at risk for nosocomial infections

Bloodstream infections were found to be the most common; invasive devices found to play a major role.

[PICUs]

[Your turn]

July 2000

ATLANTA - Nosocomial infections are an important and preventable cause of mortality in infants and children.

"Because of numerous invasive procedures and inappropriate antimicrobial use, pediatric patients in intensive care units are at particular risk for nosocomial infections," said Denise A. Garrett, MD, medical epidemiologist with the Hospital Inspections Program at the Centers for Disease Control and Prevention. Until recently, prevalence of nosocomial infections in pediatric intensive care unit (PICU) or neonatal intensive care unit (NICU) patients was unknown.

Results of a nationwide point prevalence survey indicate that 13% of patients admitted to PICUs and 11.8% of patients admitted to NICUs will acquire a nosocomial infection. Thirty-one (49.2%) of 63 Pediatric Prevention Network Hospitals participated in the nationwide survey in August 1999. A total of 35 PICUs and 29 NICUs were represented. The data were presented here at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections.

PICUs

Of children in PICUs, 67 (13%) of 514 children surveyed acquired at least one nosocomial infection. The most common infections were bloodstream infections (32 cases, 39.5%), bronchitis or trachitis (14 infections, 17.3%), urinary tract infections (11 cases, 13.6%), pneumonia (eight infections, 9.9%) and skin and soft tissue infections (six cases, 7.4%).

Microbiologic results were available for 77 (95%) of the infections. Predominant organisms included Pseudomonas aeruginosa (nine infections, 11.9%), Staphylococcus aureus and coagulase-negative staphylococci (eight infections each, 10.5%), Enterococcus faecalis and Candida albicans (seven infections each, 9.2%) and Enterobacter clocae (five cases, 6.6%). An additional 70 organisms were responsible for the other 32 (42.1%) infections.

Of 830 neonates in the NICUs studied, 98 (11.8%) acquired at least one nosocomial infection, and a total of 125 infections were reported. Researchers found bloodstream infections to be most common (65 cases, 52%), followed by pneumonia (10 infections, 8%); UTIs and conjunctivitis (nine infections each, 7.2%); necrotizing enterocolitis (eight cases, 6.4%); other lower respiratory tract infections (six cases, 4.8%); surgical site infections; skin and soft tissue infections and other infections (five cases each, 4%) and meningitis (three infections, 2.4%).

Microbiologic results were available for 110 (88%) of the infections. Coagulase-negative staphylococci were the most common organisms, responsible for 32 (24.6%) infections. Others included P. aeruginosa, Escherichia coli and E. faecalis (nine infections each, 6.9%); Klebsiella pneumoniae (eight infections, 6.2%); C. albicans(seven infections, 5.4%); S. aureus(six infections, 4.6%) and Serratia marcescens(five infections, 3.8%). Most infections (45, 34.6%) were caused by an additional 121 organisms.

For more information:

• Garrett DA, McKibben P, Levin G, et al. Prevalence of nosocomial infections in pediatric intensive care unit patients at U.S. children's hospitals. S-Th-01. Garrett DA, McKibben P, Levine G, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients at U.S. children's hospitals. S-Th-09. Both presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. March 5-9, 2000. Atlanta.

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Copyright 2000, SLACK Incorporated. Revised 15 September 2000.