Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study

Denise Von Dollinger Brito,Paulo Pinto Gontijo Filho,Daiane Silva Resende,Cristiane Silveira De Brito,Jacqueline Moreira Do Ó,Vânia Olivetti Steffen Abdallah

doi:10.1590/s0037-86822010000600006

Abstract

Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the NICU of the Uberlândia University Hospital. Data were collected through the National Healthcare Safety Network surveillance from January 2006 to December 2009. The patients were followed five times/week from their birth to their discharge or death. The study included 1,443 patients, 209 of these developed NIs, totaling 293 NI episodes, principally bloodstream infections (203; 69.3%) and conjunctivitis (52; 17.7%). Device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonias per 1000 ventilator-days. The mortality rate in neonates with NI was 11.9%. Mechanical ventilation, total parenteral nutrition, orogastric tube, previous antibiotic therapy, use of CVC and birth weight of 751-1,000g appeared to be associated with a significantly higher risk of NI (p < 0.05). In multiple logistic regression analysis for NI, mechanical ventilation and the use of CVC were independent risk factors (p < 0.05). Coagulase- negative Staphylococcus (CoNS) (36.5%) and Staphylococcus aureus (23.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and S. aureus were 81.8% and 25.3%, respectively. Frequent surveillance was very important to evaluate the association of these well-known risk factors with NIs and causative organisms, assisting in drawing the attention of health care professionals to this potent cause of morbidity.

Highlights

Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the neonatal intensive care units (NICUs) of the Uberlândia University Hospital
Most late-onset infections in neonates who have a Bloodstream infections (BSI) in NICUs of industrialized countries are caused by Gram-positive organisms (55.4-75%); coagulase-negative staphylococci (CoNS) alone are the most commonly isolated pathogens
Analysis of the data obtained suggests that participation in surveillance systems, like the National Healthcare Safety Network (NHSN), is important for feeding back individual NICU data for comparison with other literature data

Summary

INTRODUCTION

Nosocomial infections (NIs) are one of the leading causes of mortality and morbidity in neonatal intensive care units (NICUs). Most late-onset infections in neonates who have a BSI in NICUs of industrialized countries are caused by Gram-positive organisms (55.4-75%); coagulase-negative staphylococci (CoNS) alone are the most commonly isolated pathogens. Surveillance of NIs is an essential part of quality patient care; there are few reports of National Healthcare Safety Network (NHSN) surveillance use in NICUs and none in developing countries[2]. The objectives of this study were to report the incidence of NIs, causative organisms, risk factors associated with and antimicrobial susceptibility patterns through NHSN surveillance with at least four years participation in Neonatal Intensive Care Unit (NICU)

METHODS

RESULTS

Findings

DISCUSSION