Bloodstream Infections In Children Research Articles

Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections

BackgroundCatheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. MethodsTwelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls. ResultsWe administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection. ConclusionsAlthough children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children.

Bacteraemia in children in Iceland 1994–2005

To investigate the aetiology of bacteraemia in children in Iceland, the antibiotic resistance and possible preventive measures. All positive bacterial blood cultures from children 0-18 years old isolated at Landspítali University Hospital Iceland from 1994 to 2005 were included in the study. Epidemiological and microbiological data were registered. The blood cultures were categorized according to likelihood of infection or contamination. During the study period 1253 positive blood cultures were obtained from 974 children; 647 from boys and 606 from girls. Positive blood cultures were most common during the first year of life (594; 47.4%) with 252 of them from neonates. Coagulase negative staphylococci were most common (37%). Of probable or definite infections Streptococcus pneumoniae was the most common (19.3%) followed by Staphylococcus aureus (17.6%) and Neisseria meningitidis (13.5%). The most common pneumococcal serogroups were 23, 6, 7, 19 and 14. Commercially available vaccines contain up to 88% of all pneumococcal strains and 67% of all multi-resistant strains. N. meningitidis group C was not isolated after vaccinations were started in 2002. Our study provides important epidemiological data on bacterial bloodstream infections in children in Iceland. The results demonstrate the excellent efficacy of meningococcal group C vaccination.

Epidemiology and outcome of Gram-negative bloodstream infection in children: a population-based study

Population-based studies of Gram-negative bloodstream infection (BSI) in children are lacking. Therefore, we performed this population-based investigation in Olmsted County, Minnesota, to determine the incidence rate, site of acquisition, and outcome of Gram-negative BSI in children aged ⩽18 years. We used Kaplan-Meier method and Cox proportional hazard regression for mortality analysis. We identified 56 unique children with Gram-negative BSI during the past decade. The gender-adjusted incidence rate of Gram-negative BSI per 100 000 person-years was 129·7 [95% confidence interval (CI) 77·8-181·6]) in infants, with a sharp decline to 14·6 (95% CI 6·0-23·2) and 7·6 (95% CI 4·3-10·9) in children aged 1-4 and 5-18 years, respectively. The urinary tract was the most commonly identified source of infection (34%) and Escherichia coli was the most common pathogen isolated (38%). Over two-thirds (68%) of children had underlying medical conditions that predisposed to Gram-negative BSI. The overall 28-day and 1-year all-cause mortality rates were 11% (95% CI 3-18) and 18% (95% CI 8-28), respectively. Younger age and number of underlying medical conditions were associated with 28-day and 1-year mortality, respectively. Nosocomial or healthcare-associated acquisition was associated with both 28-day and 1-year mortality.

Bloodstream Infections in Children with Cancer between 2005 and 2008 in a Single Center

Purpose : In children on anticancer chemotherapy, bloodstream infections (BSIs) are a major cause of morbidity and mortality. We investigated febrile episodes and bloodstream infections in pediatric cancer patients to guide proper selection of empiric antibiotics for febrile pediatric hemato-oncologic patients. Methods : All febrile episodes treated in the division of hematology-oncology, the department of pediatrics, Hanyang University Hospital, between July 2005 and June 2008 were reviewed. Episodes with and without bloodstream infections were compared. Results : Forty cases (18.9%, 25 patients) of BSI occurred in 212 febrile episodes (63 patients). Thirty-seven cases (23.6%, 22 patients) of BSI occurred in 157 febrile episodes with neutropenia (54 patients). Microorganisms identified in BSI corresponded to 23 gram-positive bacteria (51.2%), 20 gram-negative bacteria (44.5%), and 2 fungi (4.4%). Rates of BSI between those who had received umbilical cord blood transplantation and those who had received transplantation from other source were significantly different (55.0% vs. 7.7%, P =0.001). No differences in mortality rate were observed among organisms in BSI patients. For febrile episodes the rate of BSI was higher among those with Chemoport than those with Hickman catheter (P =0.029) and gram-positive pathogens were more likely to be associated with Chemoport (P =0.001). Conclusion : The study showed the rate of BSI, distribution of pathogens with regard to neutropenia, transplantation, central venous catheters, and antimicrobial susceptibility of pathogens in order to help guide in the choice of optimal empiric antibiotics in pediatric febrile neutropenic hemato-oncologic patients.

Staphylococcus Aureus colonization and bacteremia in children with cancer.

Abstract 3666Poster Board III-602 BackgroundStaphylococcus aureus is an important cause of blood stream infections in children and adults. In recent years, new strains of methicillin-resistant S. aureus (MRSA), also known as community-acquired (CA)-MRSA have been isolated from otherwise healthy individuals. These strains frequently carry the Panton-Valentine Leukocidin (PVL) leukotoxin and belong to spa type 8; USA300 genotype, which is the most common strain causing CA-MRSA infections in the U.S. The clinical course of infections with PVL-positive S.aureus strains appears to be more severe than infection from PVL-negative strains. Bacteremia due to these strains has been reported in children, adolescents and adults. It is not known if methcillin-resistance or infection with CA-MRSA strains adversely affects outcome in children with cancer. Colonization of MRSA in healthy children has increased significantly since 2001 and has shown to be a risk factor for subsequent infection. However the prevalence of nasal and rectal colonization with MRSA; in particular with PVL-positive strains and the relationship between colonization and infection is not known in children or adults with cancer. MethodsThe epidemiology of MRSA and methicillin-sensitive S.aureus (MSSA) bacteremia and prevalence of MRSA nasal and rectal colonization in children with cancer was retrospectively studied from 2000 to 2007. Medical record review included patient demographics, underlying disease and antimicrobial susceptibility patterns of the MRSA and MSSA bacteremia isolates. Molecular typing was performed by polymerase chain reaction (PCR) on all isolates for detection of the PVL genes. Staphylococcus cassette chromosome (SCC) mec and spa typing was performed on all PVL-positive MRSA and MSSA bacteremia isolates and MRSA isolates causing colonization and infection. Demographic and treatment variables were compared between patients with MRSA and MSSA bacteremia and patients with PVL-positive and PVL-negative MRSA and MSSA bacteremia using exact two-sample Wilcoxon rank sum test or robust rank sum test for unequal variances and Fisher's exact chi-square test. The trend of MRSA/MSSA bacteremia and MRSA colonization was evaluated by logistic regression models. ResultsTen (19%) MRSA and 42 (81%) MSSA isolates from clinically distinct infectious bacteremic episodes were collected from 52 patients with cancer during the eight year study period. The proportion of cancer patients with MRSA, or MSSA bacteremia did not change significantly over the duration of the study. A third of the patients, 17 (33%), had complications. Thirty-eight (73%) of the bacteremic episodes were catheter-related. Catheters were removed significantly more often for MRSA infections than for MSSA infections for persistently positive blood cultures or complications (p=0.003). Subcutaneous ports was removed significantly more often than Hickman catheters (p= 0.005). The number of patients with persistently positive MRSA bacteremia were higher as compared to MSSA bacteremia (p= 0.004). Methicillin resistance was associated with decreased susceptibility to erythromycin (p=0.0003) and gentamicin (p=0.03). The difference in PVL positivity between MRSA and MSSA was statistically significant (P=0.01). None of the other variables studied including complications were significantly different between patients with MRSA or MSSA bacteremia or between patients with PVL-positive and PVL-negative S.aureus bacteremia. The number of patients colonized with MRSA compared to the total number of samples tested increased significantly between 2000-2001 and 2006-2007 (p=0.0007). PVL-positivity was associated both with increased colonization (p=0.004) and with an increased risk of infection (p=0.0005). There was a discordance in the spa types between the colonization and infection isolates. ConclusionsThis report represents the first description of the epidemiology of S.aureus bacteremia and colonization including analysis of PVL-positive strains in children with cancer. Methicillin-resistance or PVL-positivity did not appear to be associated with a worse outcome in our patient population. The number of patients colonized with MRSA increased significantly during this time period. PVL-positivity was associated with an increased risk of colonization and infection. Further studies are needed to confirm these observations in patients with cancer. Disclosures:No relevant conflicts of interest to declare.

Characteristics of Catheter-Related Bloodstream Infections in Children With Intestinal Failure

Catheter-related bloodstream infection is a major cause of mortality and morbidity in the intestinal-failure population. This study reports characteristics of CRBSI with implications for clinical management in parenteral nutrition-dependent children with intestinal failure. The researchers report the rate of central catheter infections, and the causative organisms, as well as identify risk factors in our intestinal-failure patients that would be amenable to preventive measures.The study is a retrospective review of the medical records of 101 patients with intestinal failure (IF), seen in the Intestinal Rehabilitation Clinic at Children's Medical Center of Dallas from May 2005 to March 2007. Catheter-related bloodstream infections (CRBSIs) were categorized as nosocomial or community-acquired. Data collected for each episode include microorganisms isolated from blood and potential risk factors. Z test was done to compare the infection rates.There were 92 episodes of CRBSIs in 45 parenteral nutrition (PN)-dependent patients with central venous catheters (CVC) in place for a total of 13,978 days. Eighty-three percent (n = 76) of CRBSIs developed in the community at a rate of 7.0 per 1,000 days. Seventeen percent (n = 16) nosocomial CRBSIs were observed at a rate of 5.5 per 1,000 catheter days. CRBSI rate was not statistically different between the two groups (7.0 vs. 5.5, p = .378).CRBSI in the intestinal-failure population is due to a wide variety of organisms with numerous risk factors. Education of CVC management with the practice of consistent guidelines may reduce CRBSI incidence, thus reducing the morbidity and mortality in the intestinal-failure patients.

Characteristics of Catheter-Related Bloodstream Infections in Children With Intestinal Failure

Characteristics of Catheter-Related Bloodstream Infections in Children With Intestinal Failure

Use of Peripherally Inserted Central Catheters to Prevent Catheter-Associated Bloodstream Infection in Children

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Horvath, B, Norville, R., Lee, D., Hyde, A., Gregurich, M.A., Hockenberry, M. (2009). Reducing central venous catheter-related bloodstream infections in children with cancer. Oncology Nursing Forum, 36, 232–238.

Horvath, B, Norville, R., Lee, D., Hyde, A., Gregurich, M.A., Hockenberry, M. (2009). Reducing central venous catheter-related bloodstream infections in children with cancer. Oncology Nursing Forum, 36, 232–238.

Prospective Incidence Study of Bloodstream Infection in Infants and Children With Central Venous Catheters After Cardiac Surgery in Italy

This prospective observational study was designed to assess the incidence of, risk factors for, and outcome of catheter-related bloodstream infection in children undergoing cardiac surgery. A staff specifically trained to handle the central venous catheters with proper aseptic techniques and an appropriate patient to medical staff ratio remain the most effective measures to prevent this infection.

High mortality among patients with positive blood cultures at a Childrens Hospital in Tbilisi, Georgia

The etiology and outcomes of blood-stream infections (BSI) among paediatric patients is not well described in resource-limited countries including Georgia. Patients with positive blood cultures at the largest paediatric hospital in the country of Georgia were identified by review of the medical and laboratory records of patients who had blood for cultures drawn between January 2004 and June 2006. Of 1,693 blood cultures obtained during the study period, 338 (20%) were positive; of these, 299 were included in our analysis. The median age was 14 days from a range of 2 days to 14 years of which 178 (60%) were male; 53% of the patients with a positive culture were admitted to the Neonatal Intensive Care Unit (NICU). Gram-negative bacilli (GNB) represented 165 (55%) of 299 cultures. Further speciation of 135 (82%) of 165 Gram-negative rod (GNR) was not possible because of lack of laboratory capacity. Overall, mortality was 30% (90 of 299). Among the 90 children who died, 80 (89%) were neonates and 68 (76%) had BSI caused by Gram-negative organisms. In multivariate analysis, independent risk factors for in-hospital mortality included an age of less than 30 days (OR=4.00, 95% CI 1.89-8.46) and having a positive blood culture for a Gram-negative BSI (OR = 2.38, 95% CI 1.32-4.29). A high mortality rate was seen among children, particularly neonates, with positive blood cultures at the largest paediatric hospital in Georgia. Because of limited laboratory capacity, microbiological identification of common organisms known to cause BSI in children was not possible and susceptibility testing was not performed. Improving the infrastructure of diagnostic microbiology laboratories in countries with limited resources is critical in order to improve patient care and clinical outcomes, and from a public health standpoint, to improve surveillance activities.

Reducing Central Venous Catheter-Related Bloodstream Infections in Children With Cancer

To determine whether a comprehensive educational program influenced the incidence of hub colonization of central venous catheters (CVCs) and bloodstream infection rates in children with cancer, to identify risk factors related to infection rates, and to determine the impact of an educational program on nurses' knowledge of CVC care for children with cancer. Prospective, longitudinal. Pediatric cancer center in a large children's hospital in the southwestern United States. 51 catheter hub cultures were obtained from 27 children with cancer, and 121 nurses participated in the educational intervention. CVC hub cultures were obtained prior to and three months after an educational intervention. A written pre- and posteducation assessment was used to evaluate the nurses' learning. Hub colonization and bloodstream infection rates. Post-test mean score of 87% was significantly higher than the pretest mean score of 72%. Prior to the education program, 57% of the hubs were culture positive, and after the educational program, the proportion of culture-positive hubs was reduced to 36%. A comprehensive educational program increases nurses' knowledge of CVC care and reduces CVC hub colonization and catheter-related bloodstream infections in children with cancer. Patient and family participation in practice changes is very important because they have the most to gain. Additional research evaluating the relationship between hub colonization and subsequent bloodstream infection in a larger sample is warranted.

Catheter-related bloodstream infections in children

Patient characteristics and system-level factors place children at increased risk for catheter-related bloodstream infection (CR-BSI). National Healthcare Safety Network data from 36 pediatric intensive care units (PICUs) demonstrate a pooled mean of 5.3 CR-BSIs per 1000 catheter-days and a median of 3.5 CR-BSIs per 1000 catheter-days. Almost 60% of CR-BSIs in children are caused by gram-positive bacteria. In the PICU setting, arterial catheterization, increased duration of catheterization, use of extracorporeal life support, and presence of a genetic abnormality are independent risk factors for CR-BSIs. ECONOMICS: In children, cost estimates range from $36,000 to $50,000 per CR-BSI. Empiric therapy should target gram-positive and gram-negative bacteria, with the choice of drug treatment based on local antimicrobial susceptibility patterns. Results from pediatric studies shows that catheter removal is indicated for all cases of candidemia and persistent bacteremia. Based on limited data, antimicrobial lock therapy may be appropriate in certain clinical situations, and multifaceted interventions are effective in reducing CR-BSIs in children. In one center, maximum barrier precautions during insertion, antimicrobial-impregnated catheters, annual hospital-wide handwashing campaigns, physical barriers between beds, and use of 2% chlorhexidine skin disinfectant decreased CR-BSIs.

Nosocomial bloodstream infections in children: an 8-year experience at a tertiary-care hospital in Finland

Laboratory-based surveillance at a Finnish paediatric tertiary-care centre during the period 1999-2006 identified 739 nosocomial bloodstream infections (BSIs) (1.6 BSIs/1000 patient-days). High rates were detected among haematology patients (4.9 BSIs/1000 patient-days) and neonatology patients (3.2 BSIs/1000 patient-days). Most BSIs (95%) were primary infections, and 75% of those were associated with a central line. The most common pathogens were coagulase-negative staphylococci (52%), Staphylococcus aureus (7%) and Candida species (6%). The overall mortality rate within 7 days after the first positive blood culture was 3%. Those who died were more likely to have been admitted to an intensive-care unit or to have undergone surgery.

Differential Time to Positivity and Quantitative Cultures for Noninvasive Diagnosis of Catheter-Related Blood Stream Infection in Children

Accurate diagnosis of catheter-related blood stream infection (CRBSI) is necessary to make a decision about removal of the catheter. Differential time to positivity (DTP) and the ratio of quantitative cultures (RQC) between central and peripheral blood cultures have not been evaluated against a strict standard in children, namely catheter tip culture. Our aim is to compare DTP and RQC in the diagnosis of catheter tip-confirmed catheter-related infection in children. Prospective study performed in 2 large hospitals in Santiago, Chile. Children with clinically suspected CRBSI had 2 peripheral and central vein blood samples obtained for automated culture in Bact/Alert and for quantitative cultures in 5% sheep blood agar plate. The catheter tip was cultured. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios (LR), and accuracy of DTP and RQC were compared against catheter tip-confirmed CRBSI. During a 3-year period, 344 clinically suspected CRBSIs were diagnosed in children of which 124 episodes met study criteria. Catheter tip culture-confirmed CRBSI in 25 (20%) of 124 episodes. A total of 34 microorganisms were cultured from 25 CRBSI; 8 of 25 (32%) episodes were polymicrobial. Staphylococcus aureus followed by coagulase-negative Staphylococcus were the most common microorganisms. For CRBSI, DTP and RQC reached a sensitivity of 75% versus 24% (P < 0.001), specificity of 86 versus 94%, positive predictive value of 58% versus 50%, negative predictive value of 93% versus 82%, LR of 5.48 versus 4.50, and accuracy of 0.84 versus 0.79. In children, DTP was better than RQC for diagnosis of catheter tip-confirmed CRBSI.

Risk determinants for catheter‐associated blood stream infections in children and young adults with cancer

Catheter-associated blood stream infections (CABSI) are frequent complications encountered with cancer treatment. In order to understand which factors might predispose to CABSIs in children and young adults, we evaluated risk for infection in association with tumor type, catheter type, and setting of occurrence. All pediatric oncology patients having a central venous catheter (CVC) with a tunneled external (TE) or totally implantable design (TID) were prospectively followed for the occurrence of a CABSI for 12 months. CABSIs were defined in accordance with the guidelines published by the Centers for Disease Control, and were quantified as the number of occurrences per 1,000 device days. Rates of CABSIs were stratified by tumor histology, type of catheter design, and setting of occurrence. Statistical comparisons were made using the Mantel-Haenzel statistic and the Cox proportional hazard model. A total of 58 CABSIs were identified in 139 patients over a period of 35,935 CVC days. The overall CABSI rate was 1.6 infections per 1,000 CVC days (95% CI 1.2, 2.1). Stratified analysis demonstrated increased risk for CABSIs in hospitalized patients having TEs, and while patients with solid tumors were also at higher risk; this association was not supported by the Cox proportional hazard model. While our baseline CABSI rate was comparatively lower than for other institutions, subset analyses identified that hospitalized cancer patients having TEs are at the highest risk for developing CABSIs. Our findings may help to guide improved methods of anticipating and controlling infections in immunocompromised patients.

Epidemiology of and Risk Factors for Acinetobacter Species Bloodstream Infection in Children

Acinetobacter species has emerged as an important cause of healthcare-associated bloodstream infections (BSI) in adults. Little is known about development of Acinetobacter spp. BSI in children. A retrospective case-control study was conducted at a tertiary care children's hospital between January 1, 2000 and July 31, 2005. All patients with Acinetobacter spp. BSI (N = 92) were compared with a random sample of patients with non-Acinetobacter spp. Gram-negative rod BSI (N = 156). Acinetobacter spp. were isolated from blood cultures in 7% of the 1269 patients with Gram-negative rod BSI during the study period. The median age of patients with Acinetobacter spp. BSI was 5.4 years (interquartile range 1.8-13.2 years) and 57% were male. Antibiotic susceptibility patterns of Acinetobacter spp. isolates varied by class: 47% were nonsusceptible to cefotaxime; 3% were nonsusceptible to imipenem; 3% were nonsusceptible to ciprofloxacin. On multivariable analysis, patients with Acinetobacter spp. BSI were significantly more likely to develop their infection in the home setting [adjusted odds ratio (OR) = 3.58; 95% confidence interval (CI): 1.89-6.79], to be male (adjusted OR = 2.25; 95% CI: 1.24-4.08), to have a solid malignancy (adjusted OR = 4.23; 95% CI: 2.00-8.95), and to have renal failure (adjusted OR = 5.16; 95% CI: 1.07-24.96). Acinetobacter spp. are an underreported cause of endemic BSI in children. Patients with Acinetobacter spp. BSI are more likely to develop their infection in the home setting compared with patients with BSI caused by other Gram-negative rods.

Nosocomial bloodstream infection in a tertiary care paediatric intensive care unit.

To determine the frequency, causative organisms and susceptibility pattern of nosocomial bloodstream infections in children. Observational study. Paediatric Intensive Care Unit of the Children's Hospital, Lahore, from January to December 2004. All children admitted to the unit during the study period were daily evaluated for features suggestive of nosocomial infection. In addition to other investigations, blood cultures were done in all suspected cases for the confirmation of nosocomial bloodstream infection (BSI). Nosocomial infection was defined according to the criteria set by Centre for Disease Control and Prevention. Demographic, microbiological and other variables were carefully studied to analyze frequency, incidence rate, spectrum of isolates and susceptibility pattern. Children with and without nosocomial BSI were compared with regard to age, duration of stay in hospital, need and duration of ventilation and the outcome. Of the total 406 admissions, 134 children were suspected to have nosocomial infection on at least 214 occasions (episodes). Blood cultures yielded growth of pathological organisms in 62 of these episodes, giving the frequency of nosocomial BSI as 15.2 per 100 admissions (62/406 episodes). Children with nosocomial bloodstream infection were found to have younger mean age (2.1 vs. 4.1 years), longer average duration of stay (13.1 vs. 6.6 days), more frequent need for ventilation (64% vs. 34%) and longer duration of ventilation (9.7 vs. 4.8 days). Majority of isolates (77%) were gram-negative bacteria; Klebsiella being the most common isolate (n= 23). Aztreonam, Ceftiazidime, Ceforuxime and Ciprofloxacin showed high resistance pattern (33-50%). Isolates showed good sensitivity to Vancomycin (100%), Imipenem (80%), Meropenem (100%) and Co-amoxiclav (88%). The frequency of nosocomial BSI in the observed setting was quite high, having marked impact on the duration of stay and outcome. Emergence of resistant pathogens is alarming.

Bloodstream Infection Caused by Stenotrophomonas maltophilia in Children

Stenotrophomonas maltophilia, a multidrug resistant Gram-negative pathogen, has become a more frequent cause of bloodstream infections (BSI). Little is known about development of S. maltophilia bacteremia in children. The objective of this study was to define risk factors and outcomes associated with S. maltophilia BSI in children. This was a retrospective case-control study conducted at The Children's Hospital of Philadelphia between January 1, 2000 and July 31, 2005. All patients with S. maltophilia BSI were compared with a random sample of patients with non-Stenotrophomonas Gram-negative rod BSI. Fifty-one cases and 103 control subjects were included in the study. The median patient age was 2 years (interquartile range: 1 day-8.5 years). Patients with S. maltophilia BSI were significantly more likely to have a malignancy and be coinfected with other organisms than those with other Gram-negative rod infections. On multivariate analysis, patients with S. maltophilia BSI were more likely to develop their infection in the home setting (adjusted OR, 4.18; 95% CI: 1.44-12.16; P = 0.009). Additionally, prior exposure to trimethoprim-sulfamethoxazole, receipt of steroids or other immunosuppressive medication in the 30 days preceding infection and black race were associated with the development of S. maltophilia BSI. Patients with Stenotrophomonas maltophilia BSI are more likely to have a polymicrobial infection and develop their infection in the home setting compared with patients with BSI caused by other Gram-negative rods.

Nosocomial Bacteremia in Children: A 15-Year Experience at a General Hospital in Mexico

To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital. Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared. A public general hospital in San Luis Potosi, Mexico. Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection. Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel. There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions. Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.