title: Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related.
abstract: BACKGROUND
  Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for NI, as well as the risk-adjusted variations in NI rates among Canadian NICUs.
  
  
  METHODS
  From January 1996 to October 1997, data on demographics, intervention, illness severity and NI rates were submitted from 17 Canadian NICUs. Infants admitted at < 4 days of age were included. NI was defined as a positive blood or cerebrospinal fluid culture after > 48 hrs in hospital.
  
  
  RESULTS
  765 (23.5%) of 3253 infants < 1500 g and 328 (2.5%) of 13228 infants > or = 1500 g developed at least one episode of NI. Over 95% of episodes were due to nosocomial bacteremia. Major morbidity was more common amongst those with NI versus those without. Mortality was more strongly associated with NI versus those without for infants > or = 1500 g, but not for infants < 1500 g. Multiple logistic regression analysis showed that for infants < 1500 g, risk factors for NI included gestation < 29 weeks, outborn status, increased acuity on day 1, mechanical ventilation and parenteral nutrition. When NICUs were compared for babies < 1500 g, the odds ratios for NI ranged from 0.2 (95% confidence interval [CI] 0.1 to 0.4) to 8.6 (95% CI 4.1 to 18.2) when compared to a reference site. This trend persisted after adjustment for risk factors, and was also found in larger babies.
  
  
  CONCLUSIONS
  Rates of nosocomial infection in Canadian NICUs vary considerably, even after adjustment for known risk factors. The implication is that this variation is due to differences in clinical practices and therefore may be amenable to interventions that alter practice.
authors: Memorial University of Newfoundland, St. John's NF, Canada. kaziz@mun.ca
authors: Khalid
authors: K
authors: Aziz
authors: Douglas D
authors: DD
authors: McMillan
authors: Wayne
authors: W
authors: Andrews
authors: Margaret
authors: M
authors: Pendray
authors: Zhenguo
authors: Z
authors: Qiu
authors: Stella
authors: S
authors: Karuri
authors: Shoo K
authors: SK
authors: Lee
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D001724:Birth Weight; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors