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

Abstract

Objective.To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital.Design.Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared.Setting.A public general hospital in San Luis Potosi, Mexico.Patients.Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection.Interventions.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.Results.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.