Neonatal Nosocomial Infections Research Articles

The HeRO score: Enhancing prognosis and predicting nosocomial infections in newborns: Insights from the neonatal intensive care unit.

Nosocomial infections pose a significant health risk to neonates, and traditional biomarkers used for diagnosis often fall short in predicting such infections. In this study, we evaluate the efficacy of the HeRO (Heart Rate Observation score), a novel predictive tool for late-onset neonatal sepsis, in improving neonatal prognosis and reducing morbidity and mortality rates. A prospective study was conducted from September 2020 to May 2021, reviewing patient evaluation for all neonates admitted to the neonatal intensive care unit during this period after the implementation of the HeRO score. Of the 100 cases studied, preterm neonates accounted for the majority (51%), with 65% being born at gestational age greater than 32 weeks and 35% born at less than 32 weeks. A male-to-female sex ratio of 1.56. Perinatal asphyxia was the primary reason for initial hospitalization, often accompanied by pulmonary neonatal infection. The HeRO score showed an increase within 24 hours of the onset of clinical signs of sepsis in 52% of cases and after 24 hours in 47% of cases. In 51% of cases, the score exhibited an increase greater than 2. Blood cultures were positive in 91% of cases. The duration of hospital stays for newborns ranged from 7 to 42 days, with an average stay for newborns whose score rose 24 hours before clinical signs. This study highlights the significance of utilizing the HeRO score for predicting nosocomial infections in neonates, despite the possibility of false assumptions. Implementing the HERO score enables early intervention, thereby improving the assumption of responsibility and reducing neonatal morbidity and mortality rates.

The Role of Neonatal Nosocomial Infection towards Health Behavior: A Multivariate Analysis and Deep Learning Approach of Informationized Health Management

Objectives: In this study, we investigated the impact of neonatal nosocomial infections on health behavior intentions using a multivariate analysis and deep learning approach within the framework of informationized health management. Methods: We analyzed the data of 155 neonates in our hospital from May 2019 to May 2020. The infected newborns were divided into an experimental and a control group, infection risk factors and their impact on health behavioral intentions were explored, and neonates were given informationized health management based on deep learning. Results: We have analyzed risk factors, infected parts of the respondents, adverse events before and after the intervention of the experimental group, and Apgar scores before and after the intervention of the experimental group. The parts of neonatal nosocomial infection were mainly in the respiratory, urinary, and digestive tracts which significantly impacted the formulation of health behaviors. The adverse events in the experimental group after the intervention was significantly lower than before (p < .05). Meanwhile, the mean Apgar score of the experimental group after the intervention was significantly higher than before (p < .001). Conclusion: Many high-risk factors for neonatal nosocomial infections significantly impact health behavior. Adopting informationized health management based on deep learning can reduce infection and improve neonates′ health.

Identification of potential novel therapeutic drug target against Elizabethkingia anophelis by integrative pan and subtractive genomic analysis: An in silico approach

Elizabethkingia anophelis is a human pathogen responsible for severe nosocomial infections in neonates and immunocompromised patients. The significantly higher mortality rate from E. anophelis infections and the lack of available regimens highlight the critical need to explore novel drug targets. The current study investigated effective novel drug targets by employing a comprehensive in silico subtractive genomic approach integrated with pangenomic analysis of E. anophelis strains. A total of 2809 core genomic proteins were found by pangenomic analysis of non-paralogous proteins. Subsequently, 156 pathogen-specific, 442 choke point, 202 virulence factor, 53 antibiotic resistant and 119 host-pathogen interacting proteins were identified in E. anophelis. By subtractive genomic approach, at first 791 proteins were found to be indispensable for the survival of E. anophelis. 558 and 315 proteins were detected as non-homologous to human and gut microflora respectively. Following that 245 cytoplasmic, 245 novel, and 23 broad-spectrum targets were selected and finally four proteins were considered as potential therapeutic targets of E. anophelis based on highest degree score in PPI network. Among those, three proteins were subjected to molecular docking and subsequent MD simulation as one protein did not contain a plausible binding pocket with sufficient surface area and volume. All the complexes were found to be stable and compact in 100 ns molecular dynamics simulation studies as measured by RMSD, RMSF, and Rg. These three short-listed targets identified in this study may lead to the development of novel antimicrobials capable of curing infections and pave the way to prevent and control the disease progression caused by the deadly agent E. anophelis.

Clinico-microbiological profile of healthcare associated infections in a neonatal intensive care unit and its relation with environmental surveillance

Healthcare associated infections (HAI’s) or nosocomial infections are frequently encountered in neonatal intensive care units (NICU’s), resulting in morbidity as well as mortality of new born babies, with varying predisposing factors and microbiological profile. This study was conducted to identify the most common HAI among the neonates admitted in the NICU, to identify the risk factors of HAI’s in neonates and to compare the bacteriological profile of culture positive cases with the results of environmental survey. This was a prospective study, conducted for a duration of one and a half years from December 2018 to May 2020. Environmental samples from the NICU as well as clinical samples from neonates admitted to the NICU of a tertiary care centre for a duration of more than 2 calendar days were collected. The most common HAI in the NICU was VAP (41.6%), followed by CLABSI (21.8%). Statistically significant risk factors for neonatal nosocomial infection were preterm birth, LSCS, presence of comorbidities, Low Birth Weight, absence of breast feeding and Apgar score. The most common Gram negative organism isolated was Acinetobacter baumannii (18.8%) and Gram positive organism as Methicillin Resistant Coagulase negative Staphylococcus (MRCoNS) (13.9%).Acinetobacter baumanni above average isolation rate was matching with the growth of the similar organism each month, according to the surveillance report. The most common HAI among neonates in our study was VAP, majority of which were caused by Gram negative bacteria. Acinetobacter baumanni was found to have an isolation rate above average on environmental surveillance, indicating its role in causing HAI’s in neonates admitted to the NICU. However, this study did not show a definitive association between HAI and the environmental surveillance report.

Aetiological Agents in Neonatal Nosocomial Sepsis and their Sensitivity Pattern from a Tertiary Care Hospital, Odisha, India: A Cross-sectional Study

Introduction: Nosocomial infections are a major problem for hospitalised neonates due to increase in morbidity, mortality, duration of hospitalisation and costs of treatment. The magnitude of this problem varies from place to place and is unique to each place as per the organisms and their resistance pattern is concerned. There is need to develop local level surveillance data on incidence of nosocomial sepsis, causative organisms, their sensitivity pattern and periodically review antibiotic policy based on this information. Aim: To determine the aetiological agents of nosocomial sepsis and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a cross-sectional study in which the cases of nosocomial infections in neonates of > 35 weeks were studied from November 2018-October 2019 at Sriram Chandra Bhanja Medical College and Hospital (S.C.B.M.C.H) and Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics (S.V.P.P.G.I.P) based on clinical findings, sepsis screen and blood culture. Blood culture is considered as gold standard for diagnosis of sepsis. Blood sample (1 mL) was collected under strict asepsis in Becton Dickinson and Company (BACTEC) and was sent for performing blood culture. The data was processed and arranged into distribution tables and cross tables using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Out of total 100 suspected cases of nosocomial sepsis, blood culture was positive in 46 (46%) of cases. Candida spp. was the most common obtained organism 9 (19.5%) followed by Klebsiella pneumoniae 8 (17.3%) and Staphylococcus aureus 8 (17.3%) each respectively. There was increased incidence of bacterial resistance to commonly used antibiotics and combinations of it, like ampicillin, gentamicin, cefotaxime, amikacin and piperacillin+ tazobactam among these bacterial isolates. Among the possible new combinations deduced from the observation, the combination of vancomycin+amikacin had sensitivity of 67.6% and can be considered as initial antibiotic combination of choice while combination with colistin and tigecycline should be reserved only for culture proven resistant cases or babies who continue to be deteriorating and critically sick while on previous combination. Conclusion: Candida spp. is the leading cause of nosocomial sepsis. Among bacterial organisms, Klebsiella pneumoniae and Staphylococcus aureus are most common. Most isolates are resistant to traditional antibiotics, hence new combination like vancomycin+amikacin are more appropriate empiric choice in present context and combination with colistin and tigecycline are reserved only for culture proven resistant sepsis.

Optimizing Meropenem Therapy for Severe Nosocomial Infections in Neonates.

Meropenem pharmacokinetics in neonates exhibits large interindividual variability due to developmental changes occurring during the first month of life. The objective was to characterize meropenem pharmacokinetics through a population approach to determine effective dosing recommendations in neonates with severe nosocomial infections. Three blood samples from forty neonates were obtained once steady-state blood levels were achieved and plasma concentrations were determined with a validated chromatographic method. Data were used to develop and validate the one-compartment with first-order elimination population pharmacokinetic model obtained by non-linear mixed effect modeling. The final model was Clearance (L/h) = 2.23 × Creatinine Clearance (L/h) and Volume of distribution(L) = 6.06 × Body Surface Area(m2) × (1 + 0.60 if Fluticasone comedication). Doses should be adjusted based on said covariates to increase the likelihood of achieving therapeutic targets. This model explains 12.9% of the interindividual variability for meropenem clearance and 19.1% for volume of distribution. Stochastic simulations to establish initial dosing regimens to maximize the time above the MIC showed that the mean probabilities to achieve the PK/PD target (PTA) for microorganisms with a MIC of 2 and 8 µg/mL were 0.8 and 0.7 following i.v. bolus of 250 and 500 mg/m2/dose q8h, respectively. Meropenem extended 4h infusion would improve PTA in neonates with augmented creatinine clearance.

The road to zero nosocomial infections in neonates-a narrative review.

AimNosocomial infections (NI) in neonates are associated with prolonged hospitalisation, adverse neurodevelopmental outcome and high mortality. Over the past decade, numerous prevention strategies have resulted in significant reductions in NI rates. In this review, we aim to provide an overview of current NI rates from large, geographically defined cohorts.MethodsPubMed, Web of Science, EMBASE and Cochrane Library were searched for evidence regarding epidemiology and prevention of NI in neonates. Extracted studies were synthesised in a narrative form with experiential reflection.ResultsDespite the abundance of geographically defined incidence proportions, an epidemiological overview of NI is difficult to provide, given the lack of consensus definition for neonatal NI and different baseline populations being compared. Successful prevention efforts have focused on implementing evidence‐based practices while eliminating outdated strategies. The most promising model for reduction in infection rates is based on quality improvement (QI) collaboratives and benchmarking, involving identification and implementation of best practices, selection of measurable outcomes and fostering a sense of community and transparency.ConclusionThe preventative rather than curative approach forms the new paradigm for reducing the burden of neonatal infections. Despite progress achieved, continued work towards improved prevention practices is required in the strive towards zero NIs.

Klebsiella oxytoca and Emerging Nosocomial Infections.

Klebsiella oxytoca is rising as a significant opportunistic pathogen causing nosocomial infections in neonates as well as adults. This pathogen's prevalence varies from 2 to 24%, but outbreaks of infections due to multidrug-resistant strains can be fatal in immunocompromised individuals with comorbidities. Klebsiella oxytoca is responsible for a wide range of ailments from colitis to infective endocarditis, other than the common urinary and respiratory tract infections. The microbe's pathogenicity has been attributed to cytotoxins' production- Tilivalline and Tilimycin, in some intestinal disorders. Klebsiella oxytoca is reported to be resistant to a wide range of antibiotics. Here, we have tried to showcase a brief overview of the emergence of Klebsiella oxytoca in healthcare facilities and the nature of resistance in this species of Klebsiella.

Incidence and risk factors of health-care-associated infection in the neonatal intensive care unit of Assiut University Children's Hospital

Introduction One of the most common causes of mortality and morbidity in neonates, particularly in developing countries is hospital-acquired infections. Healthcare-associated infections (HCAI) are common in pediatric wards and are also one of the major causes of death in neonatal intensive care units (NICUs). Risk factors involved in nosocomial infection (NI) including gestational age, birth weight, severity of illness, and its related length of hospital stay and devices used are assessed. Objective The objective of study was to detect the incidence, anatomical sites, causative organisms, and risk factors related to HCAI in NICU in Assiut University Children Hospital. Materials and methods A cross-sectional (observational descriptive) study was done in the NICU of the Assiut University Children Hospital, during a period of 12 months (from February 2018 to February 2019). A total of 150 noninfected neonates at admission were included, where blood, pus, cerebrospinal fluid, and urine specimen were collected and processed. Results Out of 150 neonates, 107 (71.3%) developed NI. Most of the infections were caused by Staphylococcus aureus (22.7%) and Klebsiella spp. (16.0%). Bloodstream infection was the main site for NI in neonates (68.3%), followed by respiratory infection (20.8%). The reported risk factors for NI were low birth weight and prematurity. The outcome of HCAIs was death in 52% of neonates. Conclusion HCAIs was reported to have high incidence rate in neonates admitted in the NICU, especially in premature and low birth weight neonates. Early detection of NI and related risk factors remain the way to manage this problem.

The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection

Background: The main pathogen for neonatal nosocomial infections is coagulase-negative staphylococci (CoNS), particularly in very low-birth-weight and premature newborns. The current study is aimed to assess the outcomes of preterm infants with CoNS infection via a retrospective analysis, to determine the correlation between the clinical profile and mortality and morbidity, and to determine the factors associated with poor outcomes. Materials and Methods: This retrospective case–control study was conducted in the Children's and Women's Health Centre of King Fahad Medical City neonatal intensive care unit in Saudi Arabia. The study period was from January 2013 to December 2019. Results: There were 1333 controls and 137 cases of CoNS infection. There was a significant association between total parenteral nutrition use, surgical insertion of a central line, inotrope use, and spontaneous intestinal perforation and CoNS infection. There was a significant association between umbilical vein catheter (UVC) and peripherally inserted central catheter (PICC) line use and CoNS infection. The use of a UVC or PICC line significantly impacted. The presence of patent ductus arteriosus also significantly impacted. Conclusions: There was a significant association between UVC and PICC line use and outcome. The presence of patent ductus arteriosus or a perforated bowel and the need for inotrope use in CoNS infection was associated with poor outcomes. Mortality, retinopathy of prematurity, and necrotizing enterocolitis requiring surgery were more common in infants with CoNS infections.

Nurses Knowledge and Practice to Prevent and Control Neonatal Nosocomial Infection in Maternal and Neonatal Units at Rajshahi Medical College Hospital- Bangladesh

Nurses Knowledge and Practice to Prevent and Control Neonatal Nosocomial Infection in Maternal and Neonatal Units at Rajshahi Medical College Hospital- Bangladesh

The Impact of the Implementation of Culture-based Antibiotic Policy on the Incidence of Nosocomial Infections in Neonates Hospitalized in Neonatal Intensive Care Unit in a General Egyptian Hospital in Upper Egypt, 2016-2018

Nosocomial infections mainly are due to inefficient cleaning in association with the uncontrollable prescription of antimicrobials resulting in the emergence of multi-drug resistant pathogens in the hospital environment. Objectives:The study aims to evaluate the impact of the implementation of culture-guided antibiotic policy with strict infection control strategies on the occurrence of nosocomial infections and the resistance pattern ofthe isolated clinical and environmental pathogens. The study was done in 2 periods. Firstly, (August 2016 – April 2017), routine disinfection procedures and the applied antibiotic policy were evaluated. Secondly, according to the results a new antibiotic policy depending on the culture sensitivity results were implemented starting from June 2017 to February 2018 in association with strict infection control practices. As a result of this intervention, A change in the type of the isolated microorganisms was observed.Antibiotic resistance was decreased. Mortality rate was reduced from 14.1% to 9.5% of neonates with nosocomial infections, the number of the prescribed antibiotics didn’t exceed 4 antibiotics decreasing the overall cost for neonates’ therapy during their hospital stay. Each hospital should have its own antibiotic policy with the application of strict infection control strategies for the control of nosocomial infection.

Effectiveness of self instructional module regarding neonatal nosocomial infection among nursing personnels

Effectiveness of self instructional module regarding neonatal nosocomial infection among nursing personnels

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17; 95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program.

A proactive environmental monitoring program was conducted to determine the risk and prevent nosocomial waterborne infections of Legionella spp. in infants. Sink taps in a neonatal intensive care unit (NICU) and two obstetric clinics were monitored for Legionella spp. A total of 59 water samples were collected during a 3-year period and 20 of them were found colonized with Legionella pneumophila. Standard culture, molecular, and latex agglutination methods were used for the detection and identification of Legionella bacteria. Hospital personnel also proceeded with remedial actions (hyperchlorination and thermal shock treatment) in the event of colonization. The minimal inhibitory concentration (MIC) values of erythromycin, ciprofloxacin was determined for Legionella isolates using the e-test method. Our data indicate that the majority of neonatal sink-taps were colonized at least once during the study with Legionella spp. Among 20 isolates, 5 were considered as low-level resistant, 3 in erythromycin and 2 in ciprofloxacin, while no resistant strains were detected. Environmental surveillance in neonatal and obstetric units is suggested to prevent waterborne infections, and thus to reduce the risk of neonatal nosocomial infections.

Effect of a surveillance system for decreasing neonatal nosocomial infections.

Nosocomial infection in very low birthweight (VLBW) infants is a common complication with high morbimortality. New strategies to reduce its occurrence have recently led to the development of neonatal surveillance programs. To determine whether the NeoKissEs surveillance system implementation in our neonatal unit has been associated with a decrease in nosocomial infection in VLBW infants, as well as a reduction in the use of antibiotics and central venous catheters (CVC). Retrospective and descriptive study of infants <1500 g admitted between January 2011 and December 2017. Rates of use of antibiotics and CVC were calculated, as well as late-onset sepsis incidence. Data were compared before and after the surveillance system implementation. 299 patients were recruited. We excluded seven patients, who died <72 h. Of the remainder (n = 292), 149 were in the pre-intervention period and 143 in the post-intervention period. We found a significant decrease in the incidence density of sepsis comparing these two periods (5.98 vs. 4.08) (p = 0.03). Although no differences in antibiotic and CVC rates of use between both groups were found, a significant decrease in antibiotic use was observed comparing the first and last year of the intervention (38% vs. 24%) (p = 0.03). A higher percentage of breastfed infants was observed (39% vs. 59%) (p = 0.001) in the post-intervention group. Surveillance systems are useful to reduce nosocomial infection in VLBW infants. Reduction in antibiotic and CVC use requires longer intervention time. Promotion of breastfeeding seems to be a very effective associated strategy.

Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study.

How to cite this article: Rambaud J, Allioux C, Jean S, Guilbert J, Guellec I, Demoulin M, et al. Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study. Indian J Crit Care Med 2019;23(9):392–395.

Measurements of C-Reactive Protein for Successful Management and Follow-Up Treatment of Neonatal Sepsis and Nosocomial Infection

Objective: To develop an optimal follow-up treatment for neonatal and nosocomial infections and to examine correlations between the C-reactive protein (C-RP) and platelets. Methods: A sample of 27 septic neonates and 14 non-septic neonates were selected for this study. The non-septic neonates served as a control group. Blood samples were collected from both groups and analyzed for bacterial contamination via blood culture, complete blood count (CBC), and C-RP, according to international laboratory standards. Blood collection and analysis were repeated every day during the follow-up treatments with antibiotics to evaluate the kinetics of C-RP. Results: Blood culture found E. coli and Staphylococcus aureus in the blood of the septic cases. Serum C-RP concentrations were at high levels (24 mg/dl) in the septic neonates and at normal levels (lower than 6 mg/dl) in the control group. Treatment with active antibiotics resulted in a drastic reduction of the C-RP values and helped to reach a normal level as in the control group. On the other hand, there were increases in the platelet levels as the C-RP levels decreased. This result indicates a strong negative association between C-RP and platelet levels in the septic group only. Statistical analysis shows significant differences between the mean C-RP serum concentrations of the sepsis and non-sepsis. Conclusion: blood culture, active antibiotics, and kinetic C-RP measurements during the medical follow-up treatment are strong driving parameters for the optimal and successful management of sepsis.

Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study.

Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.

Risk Factors for Nosocomial Infections in Neonatal Intensive Care Unit

We report our study to determine factors associated with increased nosocomial infections in neonates hospitalized in NJCU, from January until December, 1992. A total number of 116 infants were studied, 68 (58.6%) of them were male, and 101 (87 .1 %) were less than 6 days old. Forty six infants (39.8%) had a birth weight of&lt; 1500 g, 27 (23.3%) between 1500-1999 g, 14 (12.1%) between 2000-2499 g, 27 (23.2%) &gt;2500 g, and 2 (1.7%) were unknown. A total number of64 infants (55.2%) had more than 1 infections, yielding 103 episodes of infection, giving an incidence of 88.8% infection rate. The significant risk factor for nosocomial infections was length of hospital stay. Age, birth weight, gestational age, APGAR scores, use of nasogastric tube or intravenous line, were not statistically significant risk factors. Use of nasogastric tube was associated with increased nosocomial gastroenteritis, compared with use of intravenous lines.