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Nosocomial enterococcal infections in children
N Singh-Naz1, A Rakowsky, E Cantwell
1Department of Infectious Diseases, Children's National Medical Center, George Washington University School of Medicine, Washington DC 20010, USA.
Insights
Central lines, gastrointestinal issues, and multiple antibiotics increase nosocomial enterococcal infections in children. Limiting antibiotic use in high-risk patients may help control these infections.
Area of Science:
- Pediatric Infectious Diseases
- Hospital-Acquired Infections
- Antimicrobial Resistance
Background:
- Nosocomial enterococcal infections pose a significant threat in pediatric healthcare settings.
- Understanding risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To identify key factors associated with an increased risk of nosocomial enterococcal infection in pediatric patients.
- To inform targeted interventions for infection control.
Main Methods:
- A matched case-control study was conducted involving 101 pediatric cases and 101 controls.
- Data were collected via systematic review of medical records.
- Microbiology methods included isolation, identification, and antimicrobial susceptibility testing.
Main Results:
- Central line placement was identified as a significant risk factor.
- Gastrointestinal tract pathology was associated with increased infection risk.
- Administration of multiple antimicrobial agents was a key determinant.
Conclusions:
- Limiting the number of antimicrobial agents administered to hospitalized high-risk children may help control nosocomial enterococcal infections.
- Findings are particularly relevant given rising antimicrobial resistance rates.
- Targeted interventions focusing on central line care and judicious antibiotic use are recommended.
Objectives:
To identify factors that are associated with an increased risk of nosocomial enterococcal infection in children.
Methods:
A matched case-control study was conducted between January 1989 and July 1993 at the Children's National Medical Center, Washington DC. One control patient for each case was identified. Control patients did not have nosocomial enterococcal infections and were matched with cases on the basis of age and time of admission closest to the case within a three-month period. Data were collected from systematic review of patient medical records. One hundred and one study patients (cases) were matched with 101 control patients. A case was defined as a patient with enterococcal infection who met the Centers for Disease Control and Prevention criteria for nosocomial infection. Microbiology methods included isolation, identification, and antimicrobial susceptibility testing of enterococci from clinical specimens.
Results:
Risk factors associated with nosocomial enterococcal infections were determined by multiple conditional logistic regression analyses of the cases and controls. Factors identified were placement of a central line, gastrointestinal tract pathology, and administration of multiple antimicrobial agents. The median duration of antimicrobial therapy prior to diagnosis of nosocomial enterococcal infection was approximately 1 week.
Conclusion:
The incidence of nosocomial enterococcal infections in children may be controlled by limiting the number of antimicrobial agents administered to hospitalized high risk patients. The importance of our findings is relevant in an era of increasing rates of antimicrobial resistance in nosocomial enterococcal infections.