Trends in paediatric nosocomial bacteraemia in a London tertiary hospital

To describe the incidence and microbiological characteristics of nosocomial bloodstream infections in childhood over a 9-year period at a South London tertiary hospital.

Analysis of prospective data collected for clinically significant nosocomial bloodstream infections in children aged <16 years during 2001-2009.

During the study period, although the absolute number of nosocomial bloodstream infections were similar for the neonatal unit (n = 254) and paediatric wards (n = 224), rates were 11.6-fold (95% CI, 9.8-13.9) higher for the former (5.8 vs. 0.50/100 discharges, respectively). Analysis of trends revealed a significant reduction in rates for both the neonatal unit (7.8-2.5 episodes/100 discharges; p < 0.001) and paediatric wards (1.2-0.4 episodes/100 discharges; p < 0.001), mainly due a decline in catheter-associated staphylococcal bacteraemia, which accounted for 115 (45%) and 164 (73%) episodes in the paediatric wards and neonatal units, respectively. Gram-positive cocci were the most frequent pathogens recovered, accounting for 200 (79%) and 185 (83%) cases in the neonatal unit and paediatric wards, respectively. Overall, antimicrobial resistance rates were low compared with other industrialized countries.

Nosocomial bloodstream infections rates declined significantly in our hospital over the past decade, likely driven by local introduction of national infection-control bundles particularly focussing on insertion and maintenance of intravascular catheters.