Risk Factors For Hospital-acquired Infection Research Articles

Risk Factors Associated with the Development of Hospital-Acquired Infections in Hospitalized Patients with Severe COVID-19.

Recognition of risk factors for hospital-acquired infections (HAI) in patients with COVID-19 is warranted. We aimed to describe factors associated with the development of HAI in patients with severe COVID-19. We conducted a retrospective cohort study including all adult patients admitted with severe COVID-19 between March 2020 and November 2020. The primary outcome was HAI development. Bivariate and multiple logistic regression models were constructed. Among 1540 patients, HAI occurred in 221 (14%). A total of 299 episodes of HAI were registered. The most common HAI were hospital-acquired/ventilation-associated pneumonia (173 episodes) and primary bloodstream infection (66 episodes). Death occurred in 387 (35%) patients and was more frequent in patients with HAI (38% vs. 23%, p < 0.01). Early mechanical ventilation (aOR 18.78, 95% CI 12.56-28.07), chronic kidney disease (aOR 3.41, 95% CI 1.4-8.27), use of corticosteroids (aOR 2.95, 95% CI 1.92-4.53) and tocilizumab (aOR 2.68, 95% CI 1.38-5.22), age ≥ 60 years (aOR 1.91, 95% CI 1.27-2.88), male sex (aOR 1.52, 95% CI 1.03-2.24), and obesity (aOR 1.49, 95% CI 1.03-2.15) were associated with HAI. In patients with severe COVID-19, mechanical ventilation within the first 24 h upon admission, chronic kidney disease, use of corticosteroids, use of tocilizumab, age ≥ 60 years, male sex, and obesity were associated with a higher risk of HAI.

Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs

Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear. To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI). This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA). In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P.aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45). Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.

Risk factors for and incidence of hospital-acquired infections after cardiac surgery in children with congenital heart disease: a single center experience.

The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD). Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development. The patients` median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p < 0.05). In logistic regression analysis, surgical weight < 5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p < 0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD. In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.

Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic

To evaluate risk factors for hospital-acquired infection (HAI) in patients during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, including historical and concurrent cohorts. Retrospective cohort. Three Missouri hospitals, data from 1st January 2017 to 30th September 2020. Patients aged ≥18 years and admitted for ≥48h. Univariate and multi-variate Cox proportional hazards models incorporating the competing risk of death were used to determine risk factors for HAI. A-priori sensitivity analyses were performed to assess the robustness of the urine-, blood- and respiratory-culture-based HAI definition. The cohort included 254,792 admissions, with 7147 (2.8%) HAIs (1661 blood, 3407 urine, 2626 respiratory). Patients with SARS-CoV-2 had increased risk of HAI (adjusted hazards ratio 1.65, 95% confidence interval 1.38-1.96), and SARS-CoV-2 infection was one of the strongest risk factors for development of HAI. Other risk factors for HAI included certain admitting services, chronic comorbidities, intensive care unit stay during index admission, extremes of body mass index, hospital, and selected medications. Factors associated with lower risk of HAI included year of admission (declined over the course of the study), admitting service and medications. Risk factors for HAI were similar in sensitivity analyses restricted to patients with diagnostic codes for pneumonia/upper respiratory infection and urinary tract infection. SARS-CoV-2 was associated with significantly increased risk of HAI.

Prevalence, Clinical Profile and Risk Factors of Nosocomial Infection in Ayder Pediatric Intensive Care Unit, Tigray, Ethiopia.

BackgroundHospital-acquired infection (HAI) is a significant cause of increased morbidity and mortality amongst hospitalized patients and represents a considerable health and economic burden worldwide. However, evidence about HAI in pediatric ICU is limited.ObjectiveTo identify the prevalence of hospital-acquired infection (HAI), clinical profile, and its risk factors for nosocomial infection in patients admitted to the pediatric intensive care unit (PICU).MethodologyFrom a two-year retrospective chart review admitted from 2019 to 2020 to the PICU, 223 patients were selected by systematic random sampling. Data were analyzed in SPSS version 23.0. P-values <0.05 were considered significant for all tests.ResultsForty-five (20.2%) patients developed nosocomial infection (NI). The median age was 4 years with 25–50th IQR of (0.6–9). About invasive procedures done, the most common was nasogastric tube (57%), followed by mechanical ventilation (17.9%) and urinary catheter (13.9%). The main focus of the infection was chest (53.3%), followed by bloodstream infection (22%) and gastrointestinal infection (9%). The odds of HAI were 3.3 times higher among under-five compared to those aged between 5 and 18 years (AOR: 3.3, 95% CI = 1.4–8.0, p = 0.008). The odds of HAI were also 4.1 times higher in those who stayed for more than two weeks compared to those who stayed in the pediatric ICU 2 to 14 days (AOR: 4.1, 95% CI = 2.0–8.6, p < 0.001). The mean duration of mechanical ventilation in those patients with and without NI was 1.65 days and 13.96 days, respectively (AOR = 3.46, 95% CI = 1.44–9.81, p = 0.02). Patients who started antibiotics at admission and patients who were on nasogastric tube feeding were also statistically significant risk factors for developing NI (AOR = 2.67, 95% CI = 1.37–9.64, p = 0.02; AOR = 2.45, 95% CI = 1.64–6.53, p = 0.03).ConclusionThe rate of infection in this study was higher compared to some developing countries. Younger age and prolonged length of hospital stay were found to be significant risk factors for HAI.

HEALTHCARE ASSOCIATED INFECTIONS IN INTENSIVE CARE UNITS

Mădălina "Hospital-acquired infections (HAIs) are the infections that develop clinically after 48 hours of admission in the hospital. Nosocomial infections occur within 48-72 hours of admission and are characterized by significantly higher incidence of infections resistant to treatment. Exogenous or endogenous pathogenic microorganisms can cause healthcare-associated illnesses. The clinical expertise of senior physicians and some prior studies indicated that the risk factors for HAI included both the patients own characteristics, as well as extrinsic factors. Patients’ characteristics may include age, sex, body weight, intrinsic comorbidities, diabetes mellitus, and immunological factors, while external factors may be represented by invasive procedures, medications, mechanical ventilation, surgery time in minutes, reoperation, cephalosporin exposure, days of exposure to central venous catheter, and stays in intensive care units. Monitoring of HAIs and application of preventive measures are essential in order to lower their incidence. Keywords: healthcare associated infections, intensive care unit"

Pantoea Infections in the Neonatal Intensive Care Unit.

Pantoea is a plant pathogen infrequently reported to cause opportunistic bloodstream infections. This gram-negative bacillus is a rare cause of hospital-acquired infections in newborn infants with high mortality. Since the creation of the new genus Pantoea in 1989, the evidence base available to neonatal health care providers is limited. Most of the available literature consists of case reports and case series. This review aims to consolidate the current reported literature on Pantoea infections, focusing on newborn infants and the neonatal intensive care unit (NICU). Prematurity and the associated relative immunocompromised state are major risk factors for hospital-acquired infections due to Pantoea in newborn infants. Recent advances in molecular biology have improved our understanding of the cross-kingdom pathogenesis exhibited by Pantoea. Respiratory symptoms and association with central venous lines are the most common clinical presentation of Pantoea bacteremia in newborn infants. Early institution of appropriate antibiotic therapy against this organism could be lifesaving. Therefore, it is critical for neonatologists to understand the clinical spectrum of Pantoea infections in NICUs.

Structural Risk Factors for Hospital-Acquired Infections in Intensive Care Unit.

There are risk factors related to architecture and designing labeled as "structural risk factors," causing hospital-acquired infections (HAIs) which are less highlighted in the literature. Through this communication, we wish to reiterate the importance of structural risk factors such as space surrounding the patient, furniture with focus on construction and finishing materials used, and ventilation systems surrounding the patient as risk factors for HAIs and expect that these find a place in HAI prevention guidelines in the future.

Incidence and risk factors for hospital-acquired infection among paediatric patients in a teaching hospital: a prospective study in southeast Ethiopia

ObjectivesIn order to maximise the prevention of hospital-acquired infections (HAIs) and antimicrobial resistance, data on the incidence of HAIs are crucial. In Ethiopia, data about the occurrence of HAIs among...

Mortality due to hospital-acquired infection after cardiac surgery

PurposeHospital-acquired infections have been associated with significant morbidity and mortality in critically ill surgical patients. However, little is known about mortality due to hospital-acquired infections in cardiac surgery. MethodsWe conducted a retrospective analysis of prospectively collected data from the cardiac surgery unit of a university hospital. All patients who underwent cardiac surgery over a 7-year period were included. Patients with hospital-acquired infections were matched 1:1 with patients with nonhospital-acquired infections based on risk factors for hospital-acquired infections and death after cardiac surgery using propensity score matching. We performed a competitive risk analysis to study the mortality fraction due to hospital-acquired infections. ResultsOf 8853 patients who underwent cardiac surgery, 370 (4.2%) developed 500 postoperative infections (incidence density rate 4.2 hospital-acquired infections per 1000 patient-days). Crude hospital mortality was significantly higher in patients with hospital-acquired infections than in matched patients who did not develop hospital-acquired infections, 15.4% and 5.7%, respectively (P < .001). The in-hospital mortality fraction due to hospital-acquired infections in our cohort was 17.1% (12.3%-22.8%). Pseudomonas aeruginosa infection (hazard ratio, 2.09; 95% confidence interval, 1.23-3.49; P = .005), bloodstream infection (hazard ratio, 2.08; 95% confidence interval, 1.19-3.63; P = .010), and pneumonia (hazard ratio, 1.68; 95% confidence interval, 1.02-2.77; P = .04) were each independently associated with increased hospital mortality. ConclusionsAlthough hospital-acquired infections are relatively uncommon after cardiac surgery (4.2%), these infections have a major impact on postoperative mortality (attributable mortality fraction, 17.1%).

Point-prevalence surveys of hospital-acquired infections in a Chinese cancer hospital: From 2014 to 2018

BackgroundBoth hospital-acquired infection (HAI) and cancer represents major health concerns worldwide, but there is a paucity of data describing HAI in Chinese cancer patients. The objective of this study is to demonstrate the prevalence, causative agents, antimicrobial use and risk factors for HAI in a cancer hospital in Southwestern China. MethodsWe use the criteria of the Ministry of Health of the People's Republic of China to define hospital-acquired infections. One-day cross-sectional surveys were annually conducted from 2014 to 2018. Trained staff collected hospital-acquired infections, antimicrobial use and clinical characteristics data of inpatients. Multivariate logistic regression was used to determine the potential risk factors associated with HAIs. ResultsOf the 6717 patients surveyed, there were 140 patients (2.1%, 95% confidence interval, 1.7–2.4%) with 144 distinct HAIs. Lower respiratory tract infections (47, 32.6%) and surgical-site infections (29, 20.1%) were the most common HAIs. Escherichia coli was the most common pathogen (29.6%). Risk factors for HAI included younger age (<18 years) or older age (>65 years), hospitalization in the intensive care unit, presence of central catheter and undergoing surgery in the previous 30 days. The overall prevalence of patients receiving antimicrobial agents was 15.2%. ConclusionTo control hospital-acquired infections in cancer patients, surveillance and prevention strategies to infections associated with central catheters or related to surgery should be augmented.

Nasal decolonization of Staphylococcus aureus in orthopedic surgeons using mupirocin and chlorhexidine

Nasal mucosa colonization by Staphylococcus aureus is a risk factor for hospital-acquired infections. This study examined the effectiveness of a decolonization strategy on orthopedic surgeons in a teaching hospital. S aureus colonization was detected in 43.2% of the surgeons, 25% of which were methicillin-resistant S aureus strains. Eradication was documented in 61.53% of the subjects who completed the decolonization strategy. Among orthopedic surgeons, mupirocin with or without chlorhexidine decolonization strategies was effective in eradicating S aureus colonization.

Direct Cost Estimation of Infection Control Strategy in Pediatric Intensive Care Unit at Tanta University Hospital

Background: Hospital-acquired infections (HAIs) are a major complication of hospital care in adult and children. Estimating the cost of infection control is important because HAIs cost a lot by extending patient length of stay this is a major risk factor for HAI. Objectives: Estimation of the direct cost of medical infection control measures and the direct cost of hospitalization among patients with and without hospital-acquired infections in the Pediatric Intensive Care Unit at Tanta University Hospital. Subjects and Methods: fifty infants and children (with and without HAI) who were admitted to PICU were subjected to clinical examination and investigation to diagnose infection. The direct cost included feeding requirements, investigations, procedures, medications and infection control measures. Prices used according to the period from October 2016 to September 2017 for calculating patients cost. Results: The average total direct cost of hospitalization, for cases with HAI was 8940.45 EP, which was significantly higher than that for patients without HAI (2935.63 EP). There was a significant difference in the average cost per day between patients with and without HAI. The average total direct cost of management for cases with HAI was 7068.77 E.P, which was significantly higher than that for patients without HAI (2191.66 E.P). The average total infection control cost for cases with HAI was 1871.69 E.P, which was significantly higher than that for cases without HAI (743.96 E.P). The mean length of stay (LOS) in PICU was significantly longer for patients with HAI (19.08 days), while in patients without HAI was 7.44 days (range 4-11). Conclusion: The cost of infection control is much lower than the cost of hospital-acquired infections management that prolongs hospital stay causing financial losses to the health system.

Gastrointestinal carriage of Klebsiella pneumoniae is a risk factor of subsequent hospital acquired infection

With great interest we have read the position paper in a recent issue of the Clinical Infectious Diseases from Claire L. Gorrie and colleagues defining gastrointestinal (GI) carriage is a major reservoir of Klebsiella pneumoniae ( K . pneumoniae ) infection in intensive care patients (1). The results indicated the community-acquired GI carriage of K . pneumoniae was 5.9%, which was much lower than that of the hospital-acquired (HA) carriage (19%), at the ICU administration. The clinical significances of the GI K . pneumoniae carriage in ICU setting were featured as a powerful association with subsequent K . pneumoniae infections, and a direct genomic link between colonizing and infection strains. Apart from 12% infection cases resulting from nosocomial transmission, most of K . pneumoniae infections were attributable to patients’ own GI strains. Therefore, the authors conclude that the GI of Klebisell pneumonia is a significant risk factor for HA infection (1).

Hospital-acquired infection in patients with systemic lupus erythematosus: a case-control study in a southern Chinese population.

The objective of this study is to investigate the current situation of hospital-acquired infection (HAI) in lupus patients from a southern Chinese population. A case-control study was performed. Data from Jan. 2007 to Jan. 2017 were collected. Each lupus patient with HAI was compared with two control individuals without infection selected from the same period of time. Three hundred and sixty episodes of HAI were analyzed. The average Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score at admission was 13.2 ± 7.2. The respiratory tract (58.8%) was most commonly involved, followed by the bloodstream (10.9%). Most episodes were bacteria-associated (50.0%), followed by viral infection (34.8%) and fungal infection (15.2%). Pathogenic bacteria were isolated in 87 episodes, among which 60 episodes were gram-negative bacteria (GNB)-related. Multidrug-resistant strains were detected in 46.4% of bacterial isolates. Fungi were isolated in 49 episodes. Candida albicans (46.9%) was the leading pathogen. Fifty-four episodes of virus infection were confirmed. In multivariate analysis, SLEDAI score (OR 1.1, 95% CI 1.1-1.2, P < 0.001), lupus nephritis (OR 3.7, 95% CI 2.7-5.1, P < 0.001), high dose of GC (OR 2.7, 95% CI 1.8-3.9, P < 0.001), and treatment with CYC (OR 2.9, 95% CI 2.1-4.0, P < 0.001) were risk factors for HAI. HAI in Chinese lupus patients had a unique epidemiology feature, which was characterized by common respiratory tract and bloodstream involvement and predominance of GNB with a high drug resistance rate. A variety of new pathogens including fungi and viruses emerged in the HAI patients. A history of nephritis or a higher SLEDAI score in SLE patients predicted HAI. Moreover, treatment with high dose of GC and CYC was also the main risk factor for HAI.

Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study.

BackgroundHospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia.MethodA matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis.ResultThe median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03–0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17–4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively.ConclusionHealth providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.

Risk factors for hospital acquired bloodstream infections in neonatal intensive care unit of B.P. Koirala Institute of Health Sciences, Nepal

Introduction : With the development of advanced technologies in neonatal intensive care worldwide, survival rates of newborns, particularly low birth weight and premature babies are higher. This has led to longer duration of hospital stay predisposing these babies to hospital-acquired infections (HAIs). Hence it is one of the main cause of morbidity and mortality in the neonatal intensive care unit (NICU). Objective: To determine the risk factors for HAI in NICU of B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal Method: A prospective cohort study was conducted in a seven bedded teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. HAI was diagnosed according to the CDC criteria. Risk factors for HAI were analyzed with Chi-square test and Logistic regression model. A p -value of Results: The incidence rate and density of HAI were 47% and 39.3 infections per 1000 patient-days respectively. Blood stream infection (BSI) was observed as the most common form of HAI (60.2%). Low birth weight and mechanical ventilation were found to be related to hospital acquired infection (p Conclusions : Low birth weight and mechanical ventilation were the most important risk factors for HAI in NICU of BPKIHS, Nepal Sri Lanka Journal of Child Health , 2016; 46 (1): 16-22

Risk factors for hospital-acquired infection in patients with liver cirrhosis and value of ImmuKnow assay in monitoring immune cell function

Risk factors for hospital-acquired infection in patients with liver cirrhosis and value of ImmuKnow assay in monitoring immune cell function

Hospital-acquired infection in public hospital buildings in the Philippines: Is the type of ventilation increasing the risk?

Hospital-acquired infections (HAIs) are associated with increased morbidity and mortality, especially in developing countries. However, limited information is available about the risk of HAIs in naturally ventilated wards (NVWs) and mechanically ventilated intensive care units (MVICUs) of public hospitals in the Philippines. We aimed to assess the association between HAIs and type of ventilation in an urban tertiary care hospital in the Philippines. A cross-sectional point-prevalence survey of infections was done in NVWs and MVICUs of a tertiary care hospital in December 2013. Multivariate analyses were done to examine the associations between HAIs and type of ventilation and other risk factors. Of the 224 patients surveyed, 63 (28%) patients had 69 HAIs. Pneumonia was the most common HAI (35%). Wards near areas with high vehicular activity had more respiratory HAI cases. Being immunocompromised is a risk factor for HAI for pediatric and adult patients. Among pediatric patients, staying in MVICUs had a lower risk for HAIs (adjusted odds ratio [AOR]: 0.33; 95% confidence interval [CI]: 0.10-1.08) compared to staying in NVWs. For adult patients, a higher risk for HAIs (AOR: 2.41; 95% CI: 0.29-18.20) was observed in MVICUs compared to NVWs. Type of ventilation is not a risk factor for HAIs. Patients who are immunocompromised may be at a higher risk for HAI. Indoor air pollution, proximity to congested main thoroughfare, and increased human foot traffic may contribute to the susceptibility of patients to HAIs. Hospital layout should be considered in infection control.

High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey.

There is scarce information regarding hospital-acquired infections (HAIs) among children in resource-constrained settings. This study aims to measure prevalence of HAIs in Vietnamese pediatric hospitals.Monthly point prevalence surveys (PPSs) in 6 pediatric intensive care units (ICUs) in 3 referral hospitals during 1 year.A total of 1363 cases (1143 children) were surveyed, 59.9% male, average age 11 months. Admission sources were: other hospital 49.3%, current hospital 36.5%, and community 15.3%. Reasons for admission were: infectious disease (66%), noninfectious (20.8%), and surgery/trauma (11.3%). Intubation rate was 47.8%, central venous catheter 29.4%, peripheral venous catheter 86.2%, urinary catheter 14.6%, and hemodialysis/filtration 1.7%. HAI was diagnosed in 33.1% of the cases: pneumonia (52.2%), septicemia (26.4%), surgical site infection (2%), and necrotizing enterocolitis (2%). Significant risk factors for HAI included age under 7 months, intubation and infection at admission. Microbiological findings were reported in 212 cases (43%) with 276 isolates: 50 Klebsiella pneumoniae, 46 Pseudomonas aeruginosa, and 39 Acinetobacter baumannii, with carbapenem resistance detected in 55%, 71%, and 65%, respectively. Staphylococcus aureus was cultured in 18 cases, with 81% methicillin-resistant Staphylococcus aureus. Most children (87.6%) received antibiotics, with an average of 1.6 antibiotics per case. Colistin was administered to 96 patients, 93% with HAI and 49% with culture confirmed carbapenem resistance.The high prevalence of HAI with carbapenem resistant gram-negative strains and common treatment with broad-spectrum antibiotics and colistin suggests that interventions are needed to prevent HAI and to optimize antibiotic use.