A prospective study of nosocomial infection in a neonatal intensive care unit

To determine the incidence of and organisms responsible for neonatal nosocomial infection (after 72 h of age).

A 1-year evaluation of 321 consecutive septic work-ups performed on 130 of 1008 babies admitted to a neonatal intensive care unit (NICU) for more than 72 h. Fifty-seven (89%) of 64 infants of birthweight 500-999 g, 36 (34%) of 105 infants 100-1499 g, 27 (6%) of 422 infants 1500-2499 g and 10 (28%) of 477 infants of birthweight > 2500 g had at least one septic work-up.

In addition to blood culture, the evaluations included haematological score on full blood count in 94.7%, abdominal X-ray in 48%, endotracheal tube tip culture in 32.7% and lumbar puncture in only 13.1%. Blood culture was positive on 92 occasions in 75 infants (28.7% of work-ups and 7.4% of all babies admitted). Infection status was classified as definite on 40 occasions in 30 babies, and due to contamination 52 in 45 babies. Twenty of the 30 babies with definite infection were of birthweight 500-999 g. Of the 40 definite infections coagulase-negative staphylococci (CONS) were cultured from 23 babies, Gram negative bacilli in 14 and Candida spp. in three babies. Sepsis caused or contributed to the deaths of six babies.

This study identifies infants of birthweight < 1000 g as the highest risk group for nosocomial infection especially CONS. New strategies in prevention, surveillance and treatment are required for extremely low birthweight infants.