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Nosocomial infections in black South African children
M F Cotton1, F E Berkowitz, Z Berkowitz
1Department of Pediatrics, Baragwanath Hospital, Republic of South Africa.
Insights
This study found that 14.3% of children admitted to a hospital in a developing community acquired nosocomial infections. Malnutrition, young age, and prolonged hospital stays were key risk factors, with antibiotic resistance being a significant concern.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health in Developing Communities
Background:
- Nosocomial infections pose a significant threat to pediatric patients, particularly in resource-limited settings.
- Understanding the epidemiology and risk factors of hospital-acquired infections is crucial for effective prevention strategies.
Purpose of the Study:
- To prospectively investigate the incidence, risk factors, and microbial characteristics of nosocomial infections in infants and children admitted to a hospital in a developing community.
- To identify common pathogens and their antibiotic resistance patterns.
- To assess the contribution of infections acquired outside the hospital to the overall burden.
Main Methods:
- Prospective study of 1350 pediatric admissions over 5 months.
- Data collection on infection development, sites, causative organisms, and antibiotic susceptibility.
- Analysis of risk factors including malnutrition, age, and hospitalization duration.
- Tracking of infections acquired prior to or during hospital transfer.
Main Results:
- 14.3% of admissions developed nosocomial infections (22.4 per 100 admissions).
- Major risk factors identified: malnutrition, age < 2 years, and prolonged hospitalization.
- Most common infection sites: lower respiratory and gastrointestinal tracts.
- Predominant organisms: Staphylococcus aureus and Klebsiella species, with 70% in vitro antibiotic resistance.
- Significant proportion of infections (31%) occurred during diagnostic procedures or awaiting discharge.
- 4.4% of admissions had pre-existing nosocomial infections, with measles complications noted in 28 cases.
Conclusions:
- Nosocomial infections are a substantial problem in pediatric populations in developing communities, exacerbated by malnutrition and limited healthcare resources.
- High rates of antibiotic resistance among common pathogens necessitate careful antibiotic stewardship and infection control measures.
- The study highlights the need for improved infection prevention and control strategies tailored to the specific challenges of developing healthcare settings.
Abstract:
Nosocomial infections in infants and children were prospectively studied in the general wards of a hospital serving a developing community. Of 1350 admissions in 5 months, 193 (14.3%) developed 302 infections (22.4/100 admissions). The major risk factors were malnutrition, age less than 2 years and prolonged hospitalization. The most common sites of infection were the lower respiratory and gastrointestinal tracts. The most frequently isolated organisms were Staphylococcus aureus and Klebsiella species and the site of most frequent isolation was the lower respiratory tract for which the method most commonly used was endotracheal aspiration. Seventy percent of isolates were resistant in vitro to conventional antibiotics. Thirty-one percent of infections developed while the patient was awaiting a diagnostic procedure or waiting to be sent home. During the study period 60 patients (4.4% of admissions) were admitted with a nosocomial infection acquired elsewhere (31 at this hospital and 29 from other hospitals). Measles and its complications accounted for 28 of these cases and 7 deaths. This study provides information on nosocomial infections in children from a developing community.