A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units.
BACKGROUND
We report on nosocomial infections (NIs), causative organisms, and antimicrobial susceptibility patterns in neonates who were admitted to neonatal intensive care units (NICUs), and assess the performance of birth weight (BW) as a variable for risk-stratified NI rate reporting.


METHODS
A prospective, 10-year follow-up, open cohort study that involved six Brazilian NICUs was conducted. The NI incidence rates were calculated using different denominators.


RESULTS
Six thousand two hundred forty-three newborns and 450 NICU-months of data were available for analysis. This included 3603 NIs that occurred in 2286 newborns over 121,008 patient-days. The most frequent NIs were primary bloodstream infection (pBSI; 45.9%), conjunctivitis (12.1%), skin infections (9.6%), and pneumonia (6.8%). Only the pBSI (but not pneumonia or central venous catheter-related pBSI) rate distribution differed significantly with varying BW. Gram-negative rods (mainly Klebsiella sp. and Escherichia coli) were responsible for 51.6% episodes of pBSI. Gram-positive organisms (mainly coagulase-positive staphylococci) accounted for 37.4%. Candida sp. was the fourth isolated organism. A high resistance to third-generation cephalosporins was recorded in K pneumoniae and E coli isolates.


CONCLUSIONS
This report highlights the burden of NI, and identifies the major focus for future NI control and prevention programs. Except for pBSI, BW had a poor performance as a variable for risk-stratified NI rate reporting.
Couto
Renato C
RC
Health Sciences Postgraduate Course, Medicine High School, Minas Gerais Federal University, Belo Horizonte, Minas Gerais, Brazil. renatoccouto@globo.com
Carvalho
Elaine A A
EA
Pedrosa
Tânia M G
TM
Pedroso
Enio R
ER
Neto
Mozar C
MC
Biscione
Fernando M
FM
D016470:Bacteremia / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006095:Gram-Positive Cocci / Q000472:pathogenicity; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011446:Prospective Studies