Prospective incidence study of nosocomial infections in a pediatric intensive care unit

BACKGROUND: Nosocomial infections are important causes of substantial morbidity, mortality and prolonged hospital stay in pediatric intensive care units (PICU). METHODS: A prospective surveillance study was performed in the PICU at a university hospital in Barcelona during the 6 months from May through October 2000 to describe the epidemiologic profile of nosocomial infections. Centers for Disease Control and Prevention criteria were used as standard definitions for nosocomial infections. Data including extrinsic risk factors (invasive devices) associated with nosocomial infections were recorded and device-associated infections were calculated for the specific site. RESULTS: During the study period 257 patients were admitted; 15.1% (39) patients had a total of 58 nosocomial infections. The incidence of nosocomial infection was 1.5 per 100 patient-days. Patients with cardiac surgery had the highest nosocomial infection rate, 2.3 per 100 patient-days. Bacteremia (51.7%), respiratory infection (19.0%) and urinary tract infection (17.2%) were the most frequent nosocomial infections observed, and these were associated with use of invasive device. Coagulase-negative staphylococci (39%) and Pseudomonas aeruginosa (24%) were the most common organisms isolated. Nosocomial infection rates per 1000 device days were 23.9 for respiratory infection, 12.4 for bacteremia and 10.7 for urinary tract infection. The durations of hospitalization for patients with and without infection were 22.5 and 9 days, respectively (P < 0.001). CONCLUSIONS: Performance of surveillance highlights the importance of nosocomial infections and their influence in the hospital stay and can guide selection of prevention and control measures to reduce morbidity and mortality in a PICU.