Risk factors for nosocomial infections in a neonatal intensive-care unit

Auriti, Cinzia; Maccallini, A.; Liso, G. Di; Ciommo, Vincenzo Di; Ronchetti, Maria Paola; Orzalesi, M

doi:10.1053/jhin.2002.1341

Cited by 115 publications

(123 citation statements)

References 24 publications

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“…This distribution is similar to that reported by other authors [1,5,15,16], although different from some Brazilian reports [2,14], which describe pneumonia as the most common neonatal NI. The proportion of bloodstream infections in this study (68.2%) is definitely worrisome, since neonatal sepsis carries on a particular increased mortality, prolonged length of hospital stay and slower growth among very low birth weight infants and our rates are higher than those usually observed [1,3,5,15].…”

Section: Discussionsupporting

confidence: 79%

“…Additionally, neonates admitted to NICUs, especially if premature or with low birth weight, are under a profound physiologic instability and are frequently exposed to therapeutic interventions associated with infectious complications, such as invasive procedures and broad-spectrum antibiotics [4,5]. Together, these unique aspects render this population exceedingly susceptible to NIs, as well as vulnerable to more severe illness.…”

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confidence: 99%

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Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

et al. 2008

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This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

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Section: Discussionsupporting

confidence: 79%

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confidence: 99%

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

et al. 2008

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“…The previous reports, which were based on univariate analysis, suggested that lower birth weight and younger gestational age were associated with a higher risk of LNS. [8][9][10][11] After adjustment for the effects of the other variables by multivariate analysis, we found that there was no significant association between LNS and potential risk variables such as: birth weight r1500 g, gestation age r34 weeks, prenatal corticosteroid therapy, major congenital anomalies, patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing enterocolitis, usage of UAC or percutaneous central venous catheter, mechanical ventilation, or parenteral nutrition therapy. This study agrees with the previous reports 12-14 that duration of UVC usage was independently associated with the development of LNS.…”

Section: Discussionmentioning

confidence: 81%

A Bedside Prediction-Scoring Model for Late-Onset Neonatal Sepsis

et al. 2005

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OBJECTIVE:Insufficient tools for bedside prediction of late-onset neonatal sepsis (LNS) initiated this study. The objective was to develop and validate a simple prediction-scoring model for LNS defined as culture-proven sepsis occurring 72 hours after birth. METHODS:The study was performed at a university hospital in Bangkok. The derivation phase included medical records of 1870 neonates, randomly selected from 9347 records of neonates who had been hospitalized for >72 hours during 1998 to 2000, of which 1824 records were available. In all, 100 neonates were clinically suspected of sepsis and 17 had proven LNS. The validation phase included 73 neonates suspected of having sepsis during July 2002to June 2003 and 25 who had LNS. Weighted coefficients from Cox's proportional hazards model and receiveroperating-characteristic (ROC) curve analysis were used. RESULTS:The incidence density of LNS was 17/11355 (1.5/1000) person-days. A scoring model was developed and consisted of the following: hypotension (score 4), abnormal body temperature (score 3), respiratory insufficiency (score 2), neutrophil band form fraction >1% (score 2), platelet count <150 Â 10 3 /ml (score 2), and umbilical venous catheterization (1 to 7 or >7 days; score 2 or 4). The area under the ROC curves for prediction of LNS in a neonate suspected of sepsis in each of the two phases was 0.85 and 0.80, respectively (p ¼ 0.436). The mean probabilities of LNS were approximately 0.10 (low risk) for scores from 0 to 3; 0.50 (intermediate risk) for scores from 4 to 6; and 0.70 (high risk) for scores Z7. CONCLUSION:A simple prediction-scoring model for LNS was developed. Validation of the scores suggested good diagnostic performance.

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“…Advances in neonatal intensive care have led to the improved survival of prematurely born infants, but HAIs, especially BSIs, frequently complicate the hospitalization of these infants [5,10,11,64,[74][75][76]. Neonatal BSIs are categorized as early-onset infections, occurring shortly after birth as a result of perinatal infection, and as late-onset infections, usually occurring after the first week of life.…”

Section: Bloodstream Infectionsmentioning

confidence: 99%

“…This also applies to pediatric patients: patients treated in neonatal intensive care units (NICUs) or pediatric intensive care units (PICUs) are at the highest risk for HAIs [4]. Bloodstream infections (BSIs) are the most common HAIs in these settings [5][6][7][8], often leading to increased morbidity and mortality [9][10][11] as well as long-term consequences [12], and also resulting in pain and suffering of the child and the family. Furthermore, prolonged need of hospitalization due to HAIs may give rise to substantial additional costs [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Risk factors for nosocomial infections in a neonatal intensive-care unit

Cited by 115 publications

References 24 publications

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

A Bedside Prediction-Scoring Model for Late-Onset Neonatal Sepsis

314 Healthcare-Associated Infections in Pediatrics

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