Nosocomial bloodstream infection in a pediatric intensive care unit

To study the incidence of nosocomial blood stream infections (BSI) in a pediatric intensive care unit (PICU) of a tertiary care teaching hospital, identify the organisms responsible and the pattern of antibiotic resistance over one decade.

Data was retrieved from the records of PICU and Medical Microbiology laboratory of patients with a positive blood culture after 48 hours of admission to PICU over three time periods viz. 1994-1996, 1999-2001 and 2002-2003. Antibiotic sensitivity pattern was also analyzed.

861 episodes (1994-1996: 282, 1999-2001: 362 and 2002-2003: 217) of nosocomial bloodstream infection were documented in 841 patients, corresponding to 3.63, 5.94 and 4.99 episodes per 100 patient-days, respectively. Gram negative organisms were the predominant isolates; common being Klebsiella pneumoniae (20.1%), Enterobacter species (16.6%) and Acinetobacter species (8.6%). Staphylococcus aureus (16.4%) and yeast species (15.9%) were the major Gram positive isolates. Isolation of Staphylococcus aureus , Klebsiella and Acinetobacter species showed a rising trend while yeast (36.9%, 6.6% and 4.1%) showed a decline over the three time periods studied. An increasing trend of resistance to third generation cephalosporins, aminoglycosides, ciprofloxacin and newer antibiotics including combination of beta-lactam with beta-lactamase inhibitor was noted.

The predominant organisms responsible for nosocomial infection in the PICU were Klebsiella pneumoniae , Staphylococcus aureus and Enterobacter species . At present, carbapenems plus vancomycin appear to be the best choice for empiric antibiotic therapy in the PICU in Chandigarh.