Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: a 2-year prospective study.
BACKGROUND
There are few data providing rates of nosocomial bloodstream infections (NBI) in pediatric intensive care patients from developing regions of the world.


OBJECTIVE
To describe the epidemiology of NBI in a Tunisian pediatric intensive care unit (PICU).


METHODS
A prospective surveillance study from January 2004 through December 2005 was performed in the PICU of the Children's Hospital of Tunis. All patients who remained in the PICU for more than 48 hours were included. Centers for Disease Control and Prevention criteria were applied for the diagnosis of NBI.


RESULTS
Six hundred forty-seven patients aged 0 to 15 years were included. Forty-one NBIs occurred in 38 patients. The NBI rate was 7/1000 patient days (6.3/100 admissions). Twenty-seven NBIs (66%) occurred in patients with central venous catheter (CVC). CVC-associated infection rate was 14.8 per 1000 catheter days. Gram-negative rods were involved in 53.6% of NBIs. The most common organisms causing NBIs were Staphylococcus aureus (26.8%), Klebsiella pneumoniae (19.5%) and Coagulase-negative staphylococci (17%). Staphylococcus aureus was methicillin-resistant in 9.1% of cases. Eighty-seven percent of Klebsiella pneumoniae isolates had extended-spectrum beta-lactamases. The PICU crude mortality rate of infected patients was 42% (versus 5.9% in noninfected patients; P< .001). Multivariate logistic regression analyses demonstrated device utilization ratio greater than 1 (odds ratio [OR]=8.46; 95% confidence interval [CI] 3.11-23; P< .001) and previous colonization with multidrug resistant gram-negative rods (OR=2; 95% CI 1.39-2.89; P< .001) significantly related to NBI.


CONCLUSIONS
Considering the high incidence of NBI resulted from multiple drug-resistant gram-negative rods in our center, implementation of improved infection control practices is required.
Ben Jaballah
Nejla
N
Pediatric Intensive Care Unit, Children's Hospital of Tunis, Place Bab Saadoun, 1007, Tunis, Tunisia. nejla.benjaballah@rns.tn
Bouziri
Asma
A
Mnif
Khaled
K
Hamdi
Asma
A
Khaldi
Ammar
A
Kchaou
Wassim
W
D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002177:Candidiasis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology; D014416:Tunisia / Q000453:epidemiology