Healthcare-associated infections among neonates in Brazil.
OBJECTIVE
To describe the epidemiology of healthcare-associated infections (HAIs) among neonates.


METHODS
Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI.


METHODS
Seven neonatal units located in three Brazilian cities.


METHODS
All admitted neonates were included and observed until discharge.


RESULTS
Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, < or = 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, < or = 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14).


CONCLUSIONS
The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Carmem Lúcia
CL
Pessoa-Silva
Rosana
R
Richtmann
Roseli
R
Calil
Rosana Maria Rangel
RM
Santos
Maria Luiza M
ML
Costa
Ana Cristina Cisne
AC
Frota
Sergio Barsanti
SB
Wey
D001938:Brazil / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D011159:Population Surveillance; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors