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Nosocomial Infections in Pediatric Patients A European, Multicenter Prospective Study

  • Josette Raymond (a1), Yannick Aujard (a2) and European Study Group
Abstract
Objectives.

To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children.

Design:

6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center.

Setting:

20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units.

Participants:

All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria.

Results:

The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%), Candida for 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negative Staphylococcus (CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units.

The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% of Staphylococcus aureus and 89% of CNS were methicillin-resistant, and 37.5% of Klebsiella pneumoniae had an extended-spectrum β-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units.

Conclusions:

We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.

Copyright
Corresponding author
Service Microbiologie, Hôpital Saint Vincent de Paul, 82 avenue Denfert-Rochereau, 75014 Paris, France
References
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1.Haley RW, Schaberg DR, Crossley KB, Von Allmen SD, McGowan JE. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:5158.
2.Wenzel RP. The evolving art and science of hospital epidemiology. J Infect Dis 1986;153:462470.
3.Emmerson AM, Enstone JE, Griffin H, Kelsey MC, Smyth ETM. The second national prevalence survey of infection in hospitals. Overview of the results. J Hosp Infect 1996;32:175190.
4.EPINE Working Group. Prevalence of hospital-acquired infections in children. J Hosp Infect 1992;20:113.
5.Welliver RC, McLaughlin S. Unique epidemiology of nosocomial infection in a children's hospital. Am J Dis Child 1984;138:131135.
6.Burgner D, Daldon D, Hanlon M, Wong M, Kakakios A, Isaacs D. Repeated prevalence surveys of paediatric hospital-acquired infection. J Hosp Infect 1996;34:163170.
7.Ford-Jones EL, Mindorff CM, Langley JM, Allen U, Navas L, Patrick ML, et al. Epidemiologic study of 4684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J 1989;8:668675.
8.Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128140.
9.Jarvis WR. Epidemiology of nosocomial infections in pediatric patients. Pediatr Infect Dis J 1987;6:344351.
10.Dinkel RH, Lebok U. A survey of nosocomial infections and their influence on nosocomial mortality rates. J Hosp Infect 1994;28:297304.
11.Goldmann DA, Durbin WA, Freeman J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449459.
12.Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ, et al. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357361.
13.Leroyer A, Bedu A, Lombrail P, Desplanques L, Diakite B, Bingen E, et al. Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J Hosp Infect 1997;35:3745.
14.Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsis in very low-birth-weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:6371.
15.Vincent JL, Bihari DJ, Suter PM, Bruning MA, White J, Nicolas-Chanoine MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995;274:639644.
16.Donowitz LG. High risk of nosocomial infection in the pediatric critical care patient. Crit Care Med 1986;14:2628.
17.Davies HD, Ford-Jones EL, Sheng RY, Leslie B, Matlow AG, Gold R. Nosocomial urinary tract infections at a pediatric hospital. Pediatr Infect Dis J 1992;11:349354.
18.La Gamma EF, Drusin LM, Mackles AW, Machalek S, Auld PA. Neonatal infections: an important determinant of late NICU mortality in infants less than 1,000 g at birth. Am J Dis Child 1983;137:838841.
19.Drews MB, Ludwig AC, Leititis JU, Daschner FD. Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit. J Hosp Infect 1995;30:6572.
20.Wolff M, Brun-Buisson C, Lode H, Mathai D, Lewi D, Pittet D. The changing epidemiology of severe infections in intensive care units. Clin Microbiol Infect 1997;3(suppl):S36S47.
21.Ford-Jones EL. The special problems of nosocomial infection in the pediatric patient. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1992:812896.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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