Brief report
A prospective incidence study of nosocomial infections in a neonatal care unit

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Abstract

Background

Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population.

Objective

To describe the epidemiologic profile of NI in the NCU.

Methods

A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded.

Results

Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01).

Conclusions

NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.

Section snippets

Setting and surveillance procedures

The NCU at the Hospital Sant Joan de Déu in Barcelona (Spain) is a level III care neonatal reference unit with a mean annual admission rate of 524 newborns. It has 11 beds for intensive care, 20 for intermediate care, and 10 for minimal care.

An observational and prospective study included all patients admitted to the NCU during 6 months, from May through October 2000. Each patient was followed-up daily from admission until hospital discharge.

Data were recorded in a predefined format of the

Neonatal characteristics

Two hundred sixty-eight newborns were included during the study period. The mean age at admission was 2 days (SD, 7.2 days). Ninety-two percent of the neonates were younger than 7 days old. The sex distribution was 40.7% for girls and 59.3% for boys; 46% (123 infants) weighed more than 2500 g, and 42.9% (115 infants) were born after 36 weeks of gestation (Table 1).

Epidemiology of NI

Sixty-five (24.2%) neonates had a total of 88 documented NI. Forty-four (68%) had only 1 episode, and 21 (32%) had 2 or more

Discussion

This study evaluated the incidence of NI in an NCU and found a rate of 32.7 infections per 100 admissions, in agreement with rates reported in the literature, which vary between 11% and 34%.3., 4., 10. These differences may be a result of the duration and methods of surveillance used.

The program for surveillance of nosocomial infections in Spain (PREVINE) was designed as a multicentric study for defining the epidemiologic profile of NI, and the predefined format used intrinsic risk factors

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