Nosocomial Infections in Very Low Birth Weight Infants: Etiology and Risk Factors

Abstract

Objective: We aimed to find out the incidence and risk factors of nosocomial infections in VLBW neonates and to explore the microbiologic flora, sensitivity pattern and outcome. Methods: A prospective, observational study was performed in a neonatal intensive care unit of a teaching hospital. VLBW infants excluding those diagnosed with early onset sepsis, admitted to the unit between August 2012 and March 2013 were followed up for evidence of nosocomial sepsis. Results: Of 92 VLBW infants, 23 developed nosocomial sepsis, incidence rate being 25%. Decreasing birth weight (1251-1500 g, 10.9%; 1001-1250 g, 28%; 751-1000 g, 50%; P<.001) and gestational age (>33wks, 0%; 29-32wks, 21.3%; 26-28 wks, 66.7%; p<.001) were found to be associated with statistically significant increase in nosocomial sepsis rate. On multivariate logistic regression, only peripherally inserted central catheter (PICC) line was independently associated with increased risk of nosocomial sepsis (aOR 13.33, 95% CI 3.58-49.5) in VLBW. A predominance of Gram negative over Gram positive nosocomial sepsis (75% vs. 25%) with higher mortality in the Gram negative group (55% vs. 0%) was observed. Klebsiella pneumoniae was the predominant microbe (33.4%). All microbes were sensitive to first line antibiotics except Elizabeth kingia meningoseptica and one episode of K. pneumoniae. Seven (30.4%) VLBW neonates with nosocomial sepsis died. Conclusions: Among VLBW infants, the incidence of nosocomial sepsis was 25%. Lower birth weight, lesser gestational age and PICC line were important risk factors. Gram negative nosocomial sepsis was associated with higher mortality compared to Gram positive sepsis. J Microbiol Infect Dis 2017; 7(1): 7-12