RESUMO
OBJECTIVES: Patients admitted to neonatal intensive care units (NICUs) are at high risk of nosocomial infection. We conducted a national multicenter assessment of nosocomial infections in NICUs to determine the prevalence of infections, describe associated risk factors, and help focus prevention efforts. STUDY DESIGN: We conducted a point prevalence survey of nosocomial infections in 29 Pediatric Prevention Network NICUs. Patients present on the survey date were included. Data were collected on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes. RESULTS: Of the 827 patients surveyed, 94 (11.4%) had 116 NICU-acquired infections: bloodstream (52.6%), lower respiratory tract (12.9%), ear-nose-throat (8.6%), or urinary tract infections (8.6%). Infants with infections were of significantly lower birth weight (median 1006 g [range 441 to 4460 g] vs 1589 g [range 326 to 5480 g]; P <.001) and had longer median durations of stay than those without infections (88 days [range 8 to 279 days] vs 32 days [range 1 to 483 days]; P <.001). Most common pathogens were coagulase-negative staphylococci and enterococci. Patients with central intravascular catheters (relative risk = 3.81, CI 2.32-6.25; P <.001) or receiving total parenteral nutrition (relative risk = 5.72, CI 3.45-9.49; P <.001) were at greater risk of bloodstream infection. CONCLUSIONS: This study documents the high prevalence of nosocomial infections in patients in NICUs and the urgent need for more effective prevention interventions.
Assuntos
Infecção Hospitalar/epidemiologia , Inquéritos Epidemiológicos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/estatística & dados numéricos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Enterococcus/isolamento & purificação , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Controle de Infecções , Tempo de Internação , Masculino , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/etiologia , Otorrinolaringopatias/prevenção & controle , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral Total/estatística & dados numéricos , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Sepse/epidemiologia , Sepse/etiologia , Sepse/prevenção & controle , Staphylococcus/isolamento & purificação , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
We assessed the clinical significance of a reactive urine latex agglutination (LA) test in neonates without bacteriologically confirmed group B streptococcal (GBS) infection. In a retrospective review of a 3 1/2-month period, during which 367 urine specimens from newborn infants evaluated for suspected sepsis were tested by LA, 25 infants (6.9%) with sterile blood cultures but positive urine LA test results were compared with a control group of 112 infants with both blood cultures and urine LA test results negative for GBS. When the data were studied with stepwise discriminant analysis, the only variables significantly associated with a positive urine LA test result were immature to total neutrophil ratios greater than or equal to 0.16 at 0 and 12 hours. The influence of mucosal GBS colonization on urine LA test results was then investigated prospectively in 98 healthy infants (83 born to mothers colonized with GBS and 15 born to mothers with negative GBS cultures). Eight (8.2%) of the infants studied, or 8 of 52 (15.4%) infants colonized with GBS, had a positive urine LA test result. GBS was isolated from urine cultures of all infants with a positive urine LA test result. A positive urine LA test result was associated with positive GBS rectal and vaginal cultures and with increased density of colonization at those sites. We conclude that contamination of bag specimens of urine with GBS from perineal and rectal colonization may produce a positive urine LA test result in an infant with no systemic sign of infection.
Assuntos
Antígenos de Bactérias/urina , Recém-Nascido/imunologia , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/imunologia , Antígenos de Bactérias/análise , Feminino , Humanos , Recém-Nascido/sangue , Recém-Nascido/urina , Testes de Fixação do Látex , Contagem de Leucócitos , Masculino , Troca Materno-Fetal , Mucosa/microbiologia , Neutrófilos/patologia , Gravidez , Estudos Prospectivos , Reto/microbiologia , Estudos Retrospectivos , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/transmissão , Infecções Estreptocócicas/urina , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologiaRESUMO
Polyvalent pneumococcal vaccine and oral penicillin prophylaxis are frequently used in patients with functional or anatomic asplenia to protect them from fulminant Streptococcus pneumoniae sepsis. We studied nasopharyngeal colonization with pneumococci in 34 patients with sickle cell anemia (aged 6 months to 5 years) receiving penicillin prophylaxis and in 63 age- and race-matched comparison patients. Patients with sickle cell anemia had fewer positive initial pneumococcal nasopharyngeal cultures than did the comparison group (14.5% vs 34.4%, P = 0.03) and significantly lower carriage rates during the respiratory illness season of November to March (8.7% vs 40.5%, P = 0.005). Penicillin prophylaxis did not result in emergence of penicillin-resistant pneumococci or in an increased carriage rate of Haemophilus influenzae type b. Our data suggest a mechanism of action for penicillin prophylaxis and provide some evidence for the relative safety of this regimen.