Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan

BACKGROUND: We performed a prospective analysis to determine the prevalence of nosocomial infection and associated risk factors in our neonatal intensive care unit (NICU). METHODS: Data were collected prospectively on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes at 9 am every day from November 2004 through October 2005. Prevalence of nosocomial infection and infection site definitions were according to the National Nosocomial Infections Surveillance system of the Centers for Disease Control and Prevention. RESULTS: Among 528 infants enrolled, 60 (11.4%) had 97 nosocomial infections. The survival rate was 92%. The prevalence of nosocomial infections was 17.5%: bloodstream infection, 4.7%, clinical sepsis, 6.3%, pneumonia, 5.1%, urinary tract infections (UTIs), 0.7%, surgical site infection, 0.7%. Intervention-associated infection rate: central intravascular catheter-associated bloodstream infection, 13.7%, TPN-associated bloodstream infection, 15.8%, ventilator-associated pneumonia, 18.6%, surgical site infection 13.7%, urinary catheter-associated UTI, 17.3%. Cut-off values of onset of central intravascular catheter-associated bloodstream infection and ventilator-associated pneumonia were 6 days and 10 days after intervention, respectively. Patients with a birth weight <1000 g (relative risk, 11.8, 95% confidence interval, 7.66-18.18; P < .001) were at the greatest risk for nosocomial infection. CONCLUSIONS: This study revealed the high prevalence of nosocomial infections in NICU patients, and the urgent need for a national surveillance and more effective prevention interventions.     

Diarrhea in neonatal intensive care unit

AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...     

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit.

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.     

Pseudomonas aeruginosa infections in a neonatal intensive care unit

This report describes a cluster of nosocomial infections with Pseudomonas aeruginosa in a neonatal intensive care nursery. All 5 cases of P aeruginosa infection were clustered in September 1999. Aggressive infection control measures were instituted, including installation of a user-friendly handwashing soap and environmental cleaning. On the basis of the finding of persistent dirty equipment, a new full-time position was created that was dedicated to equipment cleaning. These measures were effective in eliminating the cluster. The nursery has remained free of P aeruginosa infection for more than 2 years, attesting to the success of our program.     

Nosocomial Klebsiella pneumoniae infection: clinical and hygienic measures in a neonatal intensive care unit

An outbreak in a neonatal intensive care nursery of severe infections caused by Klebsiella pneumoniae type K-17 has been studied. Over a 9-month period 20 epidemiologically linked cases of severe septicemia, meningitis and pneumonia were diagnosed. The specific epidemic strain could be identified. After introduction of a policy of hygienic measures the nosocomial infection could be eradicated although colonization still occurred. Thorough handwashing before and after the nursing care of each infant, individual gowning and disposable gloves in the care of infants below 1 500 g were important. The changing bacterial ecology of a neonatal unit should be followed closely by weekly routine throat cultures as well as by cultures of incubators and ventilation equipment. The present investigation has shown the importance of this procedure, which is mandatory for appropriate choice of antimicrobial agents when treating infections in critically ill or very low birth weight infants in the neonatal intensive care unit. Prophylactic antimicrobial treatment is not indicated. Control of K. pneumoniae nosocomial infections can only be achieved by maintaining a high standard of hygiene in the neonatal care.     

Nosocomial infections in the neonatal intensive care unit

Nosocomial infections are significant causes of morbidity and mortality in patients who require newborn intensive care. The most common bacterial pathogens are Gram-positive bacteria, including Staphylococcus epidermidis, Staphylococcus aureus, and Enterococcus species. Gram-negative enteric bacilli and Gram-negative environmental bacteria are involved in outbreaks and occasional cases of nosocomial infection. The incidence of fungal infection has increased over the past 10 years; fungemia is the most commonly recognized infection. Surveillance for nosocomial infection is essential to identify outbreaks and detect unsuspected reservoirs of pathogens. A variety of molecular techniques can be used to determine the genetic relatedness of pathogens. Prevention of infection requires the identification of contaminated equipment, education regarding infection control methods including hand washing, and the judicious use of antimicrobial agents.     

Nosocomial infection in neonatal intensive care units

Nosocomial infection rates in neonatal intensive care units range from 5% to 25%. Both endemic and epidemic infections have been documented, with causative agents including gram-positive cocci, gram-negative bacilli, and viruses. This paper reviews the host, maternal, and environmental factors that influence susceptibility of neonates. Usual preventive measures, such as nursery design, staff apparel, handwashing, employee health, and neonatal care, as well as epidemic control measures to minimize infection risks and limit transmission of infectious organisms, are discussed.     

Health care-associated infections in the neonatal intensive care unit

Neonates represent a unique and highly vulnerable patient population. Advances in medical technology that have occurred over the last few decades have improved the survival and quality of life for neonates, particularly those infants born with extreme prematurity or with congenital defects. Although immunologic immaturity and altered cutaneous barriers play some role in the vulnerability of neonates to nosocomial infections, clearly, therapeutic interventions that have proven to be lifesaving for these fragile infants also appear to be associated with the majority of infectious complications resulting in neonatal morbidity and mortality. Rates of infections in neonatal intensive care units (NICUs) have varied from 6% to 40% of neonatal patients, with the highest rates in those facilities having larger proportions of very low-birth-weight infants (birthweight < or =1000 grams) or neonates requiring surgery. Efforts to protect the vulnerable NICU infants include the following: (1) optimal infection control practices, especially good hand hygiene and good nursery design; (2) prudent use of invasive interventions with particular attention to early removal of invasive devices after they are no longer essential; and (3) judicious use of antimicrobial agents, with an emphasis on targeted (narrow spectrum) rather than broad-spectrum antibiotics and appropriate indications (proven or suspected bacterial infections).     

Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures

Background  

Pseudomonas aeruginosa, a non-fermentative, gram-negative rod, is responsible for a wide variety of clinical syndromes in NICU patients, including sepsis, pneumonia, meningitis, diarrhea, conjunctivitis and skin infections. An increased number of infections and colonisations by P. aeruginosa has been observed in the neonatal intensive care unit (NICU) of our university hospital between 2005 and 2007.     

Prevention of infection in the intensive care unit

PURPOSE OF REVIEW: To review tactics used to prevent intensive care unit infections, particularly ventilator-associated pneumonia and catheter-related bloodstream infections. RECENT FINDINGS: Health-care-associated infections in the intensive care unit are associated with elevated mortality, morbidity, and hospital costs, and increasing antibiotic resistance. The US Centers for Disease Control and Prevention recently published guidelines for the prevention of ventilator-associated pneumonia and catheter-related bloodstream infections. Though not generally recommended, selective decontamination of the digestive tract, an antibiotic prophylaxis strategy, consistently demonstrates reduction in ventilator-associated pneumonia rates and mortality but its broader use is limited by concerns of increasing resistance. The continued positive results from selective decontamination of the digestive tract require that this strategy receive significant attention in future studies. Regarding catheter-related bloodstream infections, the recommendations suggest education should be used to reduce infection rates, but it is likely that the impact of these directives is undervalued. The data demonstrate marked reduction in catheter-related bloodstream infections in both Latin America and the USA by employing a very low-tech intervention of education, performance feedback, and initiating process controls. SUMMARY: By preventing infections in the intensive care unit, not only is the expected effect to reduce injury related to the disease process, but the long-term effect is to also reduce resistance by decreasing the need for antibiotics.     

新生儿重症监护病房多重耐药菌反复感染的危险因素分析

目的?探讨新生儿重症监护病房多重耐药菌反复感染的危险因素。方法?回顾性分析2018年11月—2021年11月我院收治的100例多重耐药菌感染的新生儿,根据治疗后感染情况分为反复感染组（20例）和非反复感染组（80例）。分析患儿的感染部位和病原菌种类;比较2组患儿的一般资料;多因素Logistic回归分析影响患儿反复感染的危险因素;构建贝叶斯网络模型,并使用Netica软件进行贝叶斯网络推理;采用ROC曲线和校准曲线评价模型的区分度和准确度。结果?100例患儿主要以呼吸道感染为主,检测出多重耐药菌菌株共158株,其中革兰阴性菌占75.95%,革兰阳性菌占24.05%。多因素Logistic回归分析结果显示,住院天数≥7 d、机械通气、抗菌药物种类≥3种和抗菌药物使用时间≥7 d是患儿反复感染的独立危险因素,而出生胎龄≥37周、出生体质量≥2500 g是患儿反复感染的保护因素（P＜0.05）。ROC曲线和校准曲线显示贝叶斯网络模型具有良好的区分度和准确度。结论?临床应对患儿胎龄、出生体质量、住院天数等危险因素进行重点关注,以降低多重耐药菌反复感染的发生率。