Nosocomial bacteremia in neonates related to poor standards of care.
BACKGROUND
In developing countries, intravenous liquids are mixed and administered by nurses, sometimes under suboptimal infection control conditions. We hypothesized that outbreaks of infusate-associated neonatal bacteremias are common, and we evaluated whether they can be detected by vigilant microbiologic surveillance of infusates.


METHODS
We studied intravenous infusates administered to neonates in a Mexican hospital where mixtures of infusates were prepared in hospital wards. The study was performed in 3 stages: stage 1, initial culturing of in-use infusates under basal conditions; stage 2, prospective culturing during a cluster of clinical sepsis; and stage 3, final culturing once the outbreak was controlled.


RESULTS
In stage 1, 68 infusates were sterile, and 1 was contaminated with Staphylococcus aureus (1.45%), from 23 patients. In stage 2, of 182 infusates from 39 patients, 51 infusates (28%) were contaminated with Gram-negative rods. On the first day of stage 2, 11 of 15 infusates were contaminated with the same strain of Klebsiella pneumoniae, which continued to appear for 26 days. Another 4 strains of Gram-negative rods were also isolated during stage 2. The association between contaminated infusate and death was significant (odds ratio, 9.4; 95% confidence interval, 2-44.3; P < 0.001). Mixtures made by nurses were more likely contaminated than commercial preparations (odds ratio, 3.1; 95% confidence interval, 1.1-8.5; P = 0.037). In stage 3, there were 42 sterile infusates from 22 patients.


CONCLUSIONS
Our study suggests that poor standards of care common in hospitals from developing countries sometimes result in outbreaks of sepsis and death for newborn patients.
Macias
Alejandro E
AE
University of Guanajuato School of Medicine and General Hospital at Leon, Mexico. aaeemmhh@yahoo.com
Munoz
Juan M
JM
Galvan
Amparo
A
Gonzalez
Juan A
JA
Medina
Humberto
H
Alpuche
Celia
C
Cortes
Gabriel
G
Ponce-de-Leon
Samuel
S
D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D003906:Developing Countries; D004196:Disease Outbreaks; D004340:Drug Contamination / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000592:standards; D007363:Intensive Care Units, Neonatal / Q000592:standards; D008800:Mexico; D009741:Nursing Staff, Hospital / Q000592:standards; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total / Q000592:standards; D011446:Prospective Studies