Bactériémies nosocomiales en pédiatrie

Abstract

Objectives. – To identify pathogenic microorganisms responsible for hospital-acquired bloodstream infections and to evaluate the associated risk factors in pediatric units, in a case-control study over 30 months from January 1st 1997 to June 30th 1999. Results. – Forty-six of 855 (5.4%) positive blood cultures were attributed to nosocomial infections. They were related to 32 infectious episodes in 28 patients hospitalized for more than 48 hours. The incidence rate was 0.11 per 100 admissions. Gram-positive cocci ( n=14; 38.8%) were the most frequently isolated pathogens (7 cases of Staphylococcus aureus, 5 of coagulase-negative staphylococci), followed by enterobacteria ( n=9; 25%), Pseudomonas aeruginosa ( n=5; 13.8%) and yeasts ( n=5; 13.8%). The major risk factors for hospital-acquired bloodstream infections were: length of stay before positive blood culture (32±51 days in cases vs 15±43 days in controls, p<0.01), presence of central venous catheter 〚odds ratio (OR) : 6.05, 95% confidence interval (CI): 1.87–20.42〛, number of days with central venous catheter ( p<0.001) and parenteral nutrition (OR: 9.44, 95% CI: 2.03–50.05). Conclusion. – Central venous catheter use, length of stay, parenteral nutrition and particularly intravenous lipids are major risk factors for the acquisition of bloodstream infection in hospitalized children.