Document Detail


Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate.
MedLine Citation:
PMID:  11576003     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the factors associated with an increasing rate of nosocomial infections in infants with very low birth weights. METHODS: Retrospective review of clinical and nosocomial infection databases for all infants with birth weights of 1500 g or less admitted to an academic neonatal intensive care unit between January 1, 1991, and December 31, 1997 (N = 1184). Two study periods were compared: 1991-1995 and 1996-1997. RESULTS: Among the 1085 infants who survived beyond 48 hours, the proportion who developed nosocomial infections increased from 22% to 31% (P =.001) and the infection rate increased from 0.5 to 0.8 per 100 patient-days (P<.001) during the period from 1996 to 1997. In that same period, the median duration of indwelling vascular access increased from 10 to 16 days (P<.001), and the median duration of mechanical ventilation increased from 7 to 12 days (P<.001). Although the device-specific rate of bloodstream or respiratory infections did not change, the increase in infections was directly attributable to the increasing proportion of infants who required these devices. In both study periods, the peak incidence of initial infection occurred between 10 and 20 days of age. For the entire sample, proportional hazard models identified birth weight, duration of vascular access, and postnatal corticosteroid exposure as significant contributors to the risk of infection. CONCLUSIONS: The increasing number of technology-dependent infants was the primary determinant in the increase of nosocomial infections. Because these infections occur in a small proportion of infants, understanding the host factors that contribute to this vulnerability is necessary to decrease nosocomial infections in neonatal intensive care units.
Authors:
N Zafar; C M Wallace; P Kieffer; P Schroeder; M Schootman; A Hamvas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  155     ISSN:  1072-4710     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-09-28     Completed Date:  2001-10-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1098-104     Citation Subset:  AIM; IM    
Affiliation:
Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO 63110, USA.
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MeSH Terms
Descriptor/Qualifier:
Catheterization, Central Venous / adverse effects
Catheters, Indwelling / microbiology
Cross Infection / epidemiology*,  microbiology,  mortality
Female
Humans
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care Units, Neonatal*
Male
Missouri / epidemiology
Proportional Hazards Models
Respiration, Artificial / adverse effects
Retrospective Studies
Risk
Statistics, Nonparametric

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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