Examination of severe, hospital acquired infections affecting extremely low birthweight (ELBW) infants.

Abstract

A nationwide questionnaire survey was carried out in 77 major neonatal intensive care unit (NICU) facilities in Japan. The survey investigated severe, hospital acquired infections occurring in extremely low birthweight (ELBW) infants at each institution. The nationwide questionnaire survey involved 77 major NICU facilities and ELBW infants born in 1996. The actual status of severe infection in these infants was investigated. Replies were obtained from 57 of the 77 facilities that were sent a questionnaire (74% recovery). During the survey period, the total number of patients hospitalized in 57 facilities was 13697, of which there were 836 ELBW infants. During this period, severe infection occurred in 126 of the ELBW infants. Of those, 98 who developed delayed infection (72 h or more after birth) on the basis of the date of onset were investigated. Methicillin-resistant staphylococcus aureus (MRSA) was the most common organism found, (38 infants, 38.8%), followed by Pseudomonas (10 infants, 10.2%) and Candida (8 infants, 8.2%). Septicemia was present in 67 patients (68.4%), while pneumonia and gastrointestinal complications were found in 15 patients (15.3%). With respect to therapy, the selection of antibiotics varied between facilities. Vancomycin (VCM) was used in 31 cases (31.6%) because MRSA was the most common organism. VCM was used from the early stage of treatment in as many as 20 infants (20.4%). Fifty-eight infants survived (59.2%), 28 infants died (28.6%), and 12 subsequentially had obvious complications (12.2%). It was confirmed that severe, hospital acquired infections caused by MRSA are still a significant problem in many institutions. Despite active prevention and treatment, the incidence of severe, hospital acquired infection has not decreased and the prognosis has not improved. Considering the inadequacy of the medical care environment in Japan, it seems impossible to solve these problems at present.