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Epidemiologic study of 4684 hospital-acquired infections in pediatric patients
E L Ford-Jones1, C M Mindorff, J M Langley
1Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study found a 6.0% nosocomial infection rate in a pediatric hospital, with highest risks in Neonatal Intensive Care Units and among infants. Gram-positive bacteria were the most common cause of these hospital-acquired infections.
Area of Science:
- Pediatric Healthcare
- Infectious Disease Epidemiology
- Hospital-Acquired Infections
Background:
- Nosocomial infections pose a significant threat in pediatric healthcare settings.
- Understanding infection rates and patterns is crucial for improving patient safety.
- University pediatric hospitals require continuous surveillance of hospital-acquired infections.
Purpose of the Study:
- To determine the incidence and characteristics of nosocomial infections in a university pediatric hospital.
- To identify high-risk wards, patient demographics, and common etiologic agents.
- To inform targeted infection control strategies.
Main Methods:
- Retrospective analysis of 4684 nosocomial infections over a 4-year period.
- Inclusion of 78,120 admitted patients.
- Calculation of nosocomial infection rates (NIR) across different wards and age groups.
Main Results:
- Overall NIR was 6.0%, with significant variation across units (0.17-14.0).
- Highest NIR observed in Neonatal Intensive Care Unit, infant neurosurgery, and hematology/oncology wards.
- Infections were most prevalent in patients ≤23 months (NIR=11.5), decreasing with age.
- Gastrointestinal infections (35%) and bacteremia (21%) were most common; Gram-positive bacteria (50%) were the leading cause.
Conclusions:
- Pediatric intensive care units and younger age groups represent critical areas for infection control.
- The high incidence of Gram-positive bacterial infections necessitates specific preventive measures.
- Long-term surveillance and targeted interventions are essential to reduce hospital-acquired infections in pediatric populations.
Abstract:
During a 4-year period 4684 nosocomial infections occurred in a university pediatric hospital which admitted 78,120 patients (nosocomial infection rate (NIR) = 6.0). NIR varied from 0.17 to 14.0 on different wards or services; the highest rates (greater than or equal to 5.6) were found in the Neonatal Intensive Care Unit, infant neurosurgery, hematology/oncology, neonatal surgery, cardiology/cardiovascular surgery, Pediatric Intensive Care Unit and infant/toddler medicine areas. Infections were most common in patients less than or equal to 23 months (NIR = 11.5), were less common in the 2- to 4-year age group (NIR = 3.6) and occurred least frequently in patients greater than or equal to 5 years (NIR = 2.6). The median day of onset of infections was 15.3 days. The proportional frequencies of infections were: 35% gastrointestinal; 21% bacteremia; 16% respiratory (10% upper, 6% lower); 7% postoperative wound; 6% urinary tract; 5% skin (32% of these skin infections were related to intravascular lines); 5% eye; 3% cerebrospinal fluid; and 2% other. A similar proportional frequency of 379 infections in patients hospitalized for more than 100 days was observed. The etiologic agents were Gram-positive bacteria (50%), viruses (23%), Gram-negative bacteria (18%), fungi (4%) and mixed/other (5%).