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Risk Factors for Nosocomial Infection in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Renato C. Couto*
Affiliation:
Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
Tania M. G. Pedrosa
Affiliation:
Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
Cristina de Paula Tofani
Affiliation:
Neocenter S/A, Belo Horizonte, Minas Gerais, Brazil
Enio R. P. Pedroso
Affiliation:
Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
*
348 Alameda dos Ipês street, Bosque da Ribeira, Nova Lima, Minas Gerais, Brazil 34000000 (renatoccouto@globo.com)

Abstract

Objective.

To determine risk factors for nosocomial infection in a neonatal intensive care unit (NICU).

Design.

A prospective, open cohort study.

Setting.

A 22-bed NICU.

Patients.

Neonates admitted to a single NICU during 1994-1998 were included in the study. Outcome variables included central venous catheter (CVC)–associated primary bloodstream infection (BSI), non–CVC-associated primary BSI, pneumonia, and overall nosocomial infection. Independent variables included birth weight, use of mechanical ventilation (MV), duration of MV, use of a CVC, duration of CVC use, duration of NICU stay, gestational age, congenital malformation, maximum (ie, worst) base excess, and maximum and minimum fraction of inspired oxygen (FIO2) for maintaining appropriate blood saturation levels during the first 12 hours after NICU admission.

Results.

A total of 1051 neonates were admitted to the NICU. Overall, 358 NIs were diagnosed. Non–CVC-associated primary BSI was the most frequent nosocomial infection (in 195 neonates [54.5%]), followed by pneumonia (46 [12.8%]), and CVC-associated primary BSI (35 [9.8%]). The mortality rate was 16%. In the final logistic regression model, the following 5 risk factors were found to be predictive of nosocomial infection development: use of MV, longer duration of MV, longer duration of CVC use, longer duration of NICU stay, and low maximum appropriate FIO2.

Conclusion.

Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in NICUs. In our cohort, birth weight showed no influence on the development of nosocomial infection. Low maximum FIO2 influenced the occurrence of overall nosocomial infection.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Singh, N. Large infection problems in small patients merit renewed emphasis on prevention. Infect Control Hosp Epidemiol 2004; 25:714716.CrossRefGoogle ScholarPubMed
2.Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001; 139:821827.Google Scholar
3.Brady, MT. Health care-associated infections in the neonatal intensive care unit. Am J Infect Control 2005; 33:268275.Google Scholar
4.Nambiar, S, Singh, N. Change in epidemiology of health care–associated infections in the neonatal intensive care unit. Pediatr Infect Dis J 2002; 21:839842.Google Scholar
5.Jarvis, WR. Controlling healthcare-associated infections: the role of infection control and antimicrobial use practices. Semin Pediatr Infect Dis 2004; 15:3040.CrossRefGoogle ScholarPubMed
6.Pessoa-Silva, CL, Richtmann, R, Calil, R, et al. Healthcare-associated infections among neonates in Brazil. Infect Control Hosp Epidemiol 2004; 25:772777.Google Scholar
7.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128140.Google Scholar
8.The International Neonatal Network. The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet 1993; 342:193198.Google Scholar
9.Gaynes, RP, Martone, WJ, Culver, DH, et al. Comparison of rates of nosocomial infections in neonatal intensive care units in the United States. Am J Med 1991;91(Suppl 3B):192S196S.Google Scholar
10.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high risk nurseries in the United States: National Nosocomial Infections Surveillance System. Pediatrics 1996;98(3 Pt 1):357361.Google Scholar
11.Richardson, DK, Gray, JE, McCormick, MC, Workman, K, Goldmann, DA. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics 1993; 91:617623.CrossRefGoogle ScholarPubMed
12.Beck-Sague, CM, Azimi, P, Fonseca, SN, et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J 1994; 13:11101116.Google Scholar
13.Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110:285289.CrossRefGoogle ScholarPubMed
14.Stoll, BJ, Gordon, T, Korones, SB, 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.Google Scholar
15.Makhoul, IR, Sujov, P, Smolkin, T, Lusky, A, Reichman, B. Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics 2002; 109:3439.Google Scholar
16.Apisarnthanarak, A, Holzmann-Pazgal, G, Hamvas, A, Olsen, MA, Fraser, BJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003; 112:12831289.Google Scholar
17.National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470485.Google Scholar
18.Goldmann, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981; 144:449459.Google Scholar
19.Freeman, J, Platt, R, Epstein, MF, Smith, NE, Sidebottom, DJ, Goldmann, DA. Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding. Am J Epidemiol 1990; 132:11301140.Google Scholar
20.Fowlie, PW, Gould, CR, Parry, GJ, Phillips, G, Tarnow-Mordi, WO. CRIB (clinical risk index for babies) in relation to nosocomial bacteraemia in very low birthweight or preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 75:F49F52.Google Scholar
21.Stoll, BJ, Gordon, T, Korones, SB, et al. Early-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; 129:7280.CrossRefGoogle ScholarPubMed
22.Stoll, BJ, Hansen, N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol 2003; 27:293301.CrossRefGoogle ScholarPubMed