medigraphic.com
ISSN 0016-3813 (Print)

2015, Number 6

<< Back Next >>

Gac Med Mex 2015; 151 (6)

Risk factors for nosocomial infection in a level III Neonatal Intensive Care Unit

García H, Torres-Gutiérrez J, Peregrino-Bejarano L, Cruz-Castañeda MA

Language: Spanish
References: 40
Page: 711-719
PDF size: 107.71 Kb.


ABSTRACT

Introduction: Nosocomial infections are a major and a frequent problem in neonatal intensive care units and increase morbidity, mortality, and costs. The objective of this study was to identify the risk factors associated with nosocomial infections in a neonatal intensive care unit. Methods: Nested case control study. Records from patients were registered: gestational age, sex, birth weight, central venous catheter and other devices, congenital malformations, surgeries, mechanical ventilation, steroid use, H2 blockers, length of stay in neonatal intensive care unit, type of infection, and etiological agent. Results: We studied 188 cases with nosocomial infections and 192 controls without nosocomial infections. The most frequent infection was sepsis (34.8%) and coagulase negative Staphylococcus was the principal etiological agent (37.2%). The risk factors associated with nosocomial infection were central venous catheter (OR: 7.3; 95% CI: 2.3-22.8), duration of neonatal intensive care unit stay › 14 days (OR: 3.4; 95% CI: 1.7-6.7), H2 blockers (OR: 2.3; 95% CI: 1.2-4.2), number of surgeries ≥ 2 (OR: 3; 95% CI: 1.1-7.9) and mechanical ventilation › 7 days (OR: 2.1; 95% CI: 1.1-4.2). Conclusions: Some risk factors associated to nosocomial infections in this study are similar to those found previously, with the exception of the number of surgeries that was not reported in previous studies.


REFERENCES

  1. Clark R, Powers R, White R, Bloom B, Sánchez P, Benjamin D. Nosocomial infection in the NICU: A medical complication or unavoidable problem. J Perinatol. 2004;24(6):382-8.

  2. Molina-Cabrillana J, Santana-Reyes C, Hernández J, López I, Dorta E. [Incidence of nosocomial infections at a neonatal intensive care unit: a sixyear surveillance study]. Enferm Infecc Microbiol Clin. 2006;24(5):307-12.

  3. Lachassine E, Letamedia R, Gaudelus E. [Epidemiology of nosocomial infections in neonates]. Arch Pediatr. 2004;11(3):229-33.

  4. Carey A, Saiman L, Polin R. Hospital-acquired infections in the NICU: Epidemiology for the new millenium. En: Hermansen M, ed. Clinics in Perinatology. EE.UU.: Elsevier; 2008. p. 223-49.

  5. Nagata E, Brito C, Matsuo T. Nosocomial infections in a neonatal intensive care unit: Incidence and risk factors. Am J Infect Control. 2002;30(1):26-31.

  6. Avila-Figueroa C, Cashat-Cruz M, Aranda-Patrón E, et al. [Prevalence of nosocomial infections in children: survey of 21 hospitals in Mexico]. Salud Publica Mex. 1999;41 Supl 1:S18-25.

  7. Morayta-Ramírez A, Granados-Galván E, Pérez-Peláez GC, Domínguez- Viveros W. Incidencia de infecciones nosocomiales en la Coordinación de Pediatría del CMN «20 de Noviembre». Rev Enf Infecc Pediatr. 2006;19:71-8.

  8. Hernández-Orozco HG, González-Saldaña N, Castañeda- Narváez JL, et al. Infecciones nosocomiales en el Instituto Nacional de Pediatría (INP) 2004-2005. Acta Pediatr Mex. 2006;27:325-8.

  9. García H, Martínez-Muñoz AN, Peregrino-Bejarano L. [Epidemiology of nosocomial infections in a neonatal intensive care unit]. Rev Med Inst Mex Seguro Soc. 2014;52 Suppl 2:S30-7.

  10. Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. En: Hermansen M, ed. Clinics in Perinatology. EE.UU.: Elsevier; 2008. p. 199-222.

  11. Richards M, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1999;103(4):e39.

  12. Nambiar S, Singh N. Change in epidemiology of health care associated infections in a neonatal intensive care unit. Pediatr Infec Dis J. 2002;21(9):839-42.

  13. Couto R, Tofani C, Pedroso A. Risk factors for nosocomial infection in a neonatal intensive care unit infection control and hospital epidemiology. Infect Control Hosp Epidemiol. 2006;27(6):571-5.

  14. Garland J, Uhing M. Strategies to prevent bacterial and fungal infection in the neonatal intensive care unit. En: Uhing M, Kliegman R, eds. Clinics in Perinatology. EE.UU.: Elsevier; 2009. p. 1-13.

  15. Coria-Lorenzo JG, Francisco-Revilla Estivill N, Soto-Romero IE, Saavedra- Barrios MA, Gadea-Álvarez T. Epidemiología de las infecciones nosocomiales neonatales, en un hospital de especialidades pediátricas de la ciudad de México (revisión de 3 años). Perinatol Reprod Hum. 2000;14:151-9.

  16. Peregrino-Bejarano L, Villegas-Silva R, Leaños-Miranda B, Solórzano-Santos F, Miranda-Novales MG. Cefalotina y amikacina para tratamiento de Sepsis neonatal de adquisición nosocomial en una unidad de cuidados intensivos neonatales. Bol Med Hosp Infant Mex. 2004;61:393-401.

  17. Aziz K, McMillan, Andrews W, Pendray M, et al. Variations in rates of nosocomial infection among canadian neonatal intensive care units may be practice-related. BMC Pediatr. 2005;5(1):1-12.

  18. Olsen A, Reinholdt J, Jensen A, Andersen L, Jensen E. Nosocomial infection in a danish neonatal intensive care unit: a prospective study. Acta Paediatr. 2009;98(8):1294-9.

  19. Barbazono A, Kitajima H, Nishimaki S, et al. Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese nosocomial infection surveillance (JANIS). Acta Med Okayama. 2008;62(4):261-8.

  20. Alvarez G, Amaro C. Costos atribuibles y factores de riesgo de infección nosocomial en un hospital pediátrico del estado de sonora, 2008. Bol Med Hosp Infant Mex. 2010;67:118-27.

  21. Robles M, Díaz J, Jarvis W, Rodríguez, Rey C. [Risk factors associated with nosocomial bacteremia in low birth weight neonates. Grady Memorial Hospital, Atlanta]. Gac Sanit. 2001;15(2):111-7.

  22. Cimiotti J, Haas J, Saiman L, Larson E. Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 2006;160(8):832-6.

  23. Carrieri MP, Stolfi I, Moro ML; Italian Study Group on Hospital Acquired Infections in Neonatal Intensive Care Units. Intercenter variability and time of onset: Two crucial issues in the analysis of risk factors for nosocomial sepsis. Pediatr Infect Dis J. 2003;22(7):599-608.

  24. Geffers C, Gastmeier A, Schwab F, Groneberg K, Rüden H, Gastmeier P. Use of central venous catheter and peripheral venous catheter as risk factors for nosocomial bloodstream infection in very-low-birth-weight infants. Infect Contr Hosp Epidem. 2010;31(4):395-401.

  25. Pooli L, Nocetti-Fasolino M, De Califano GM, Rial MJ, Martín MT. Incidencia de infección hospitalaria y factores de riesgo asociados en una unidad de cuidados intensivos e intermedios neonatales. Rev Hospital Pedro de Elizalde. 2002;1:1-7.

  26. Perlman S, Saiman L, Larson E. Risk factors for late-onset health care- associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control. 2007;35(3):177-82.

  27. Xu XF, Ma XL, Chen Z, Shi LP, Du LZ. Clinical characteristics of nosocomial infections in neonatal intensive care unit in eastern China. J Perinat Med. 2010;38(4):431-7.

  28. Zafar N, Wallace C, Kieffer P, Schroeder P, Schootman M, Hamvas A. Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate. Arch Pediatr Adolesc Med. 2001; 155(10):1098-104.

  29. Rojas M, Efird M, Lozano J, et al. Risk factors for nosocomial infections in selected neonatal intensive care units in Colombia, South America. J Perinatol. 2005;25(8):537-41.

  30. Horan T, Andrus M, Dudeck M. CDC Surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.

  31. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):1-8.

  32. Vieira CFTAC, Castro A, Militao M, Girao J, Braga K, Fernandes L. Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit. BJID. 2008;12(1):75-9.

  33. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365(9465):1175-88.

  34. Mäki M, Ruuska T, Kusuusela A, Karikoski L, Ikonen R. High prevalence of asymptomatic esophageal and gastric lesions in preterm infants in intensive care. Crit Care Med 1993;21(12):1863-7.

  35. Dinsmore J, Jackson R, Smith D. The protective role of gastric acidity in neonatal bacterial translocation. J Pediatr Surg. 1997;32(7):1014-6.

  36. Bianconi S, Gudavalli M, Sutija VG, Lopez AL, Barillas-Arias L, Ron N. Ranitidine and late-onset sepsis in the neonatal intensive care unit. J Perinat Med. 2007;35(2):147-50.

  37. Terrin G, Passariello A, De Curtis M, Manguso F, et al. Ranitidine is associated with infections, necrotizing enterocolitis, and fatal outcome in newborns. Pediatrics. 2012;129(1):e40-5.

  38. Graham PL III, Begg MD, Larson E, Della-Latta P, Allen A, Saiman L. Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J. 2006;25(2):113-7.

  39. Shankar KR, Brown D, Hughes J, et al. Classification and Risk-Factor Analysis of Infections in a Surgical Neonatal Unit. Pediatr Surg. 2001; 36(2):276-81.

  40. Maraqa NF, Aigbivbalu L, Masnita-Iusan C, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control. 2011;39(1):35-41.




2020     |     www.medigraphic.com