title: Do pacifiers increase the risk of nosocomial diarrhoea? A cohort study.
abstract: METHODS
  Prospective cohort study.
  
  
  METHODS
  Teaching paediatric hospital-Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast Brazil.
  
  
  METHODS
  378 of 536 infants admitted in paediatric wards from April to October 2009 were daily assessed during hospital stay until the first episode of nosocomial diarrhoea (ND), death or discharge. Infants with community-acquired diarrhoea, respiratory or haemodynamic instability and who stayed in hospital for <24 h were excluded.
  
  
  METHODS
  Incidence and risk factors for ND and rates of pacifier faecal contamination.
  
  
  RESULTS
  33 ND episodes occurred in 378 infants, with a cumulative incidence of 8.7% and density of 11.25/1000 patients-day. ND occurred in 8.2% (16/194) of pacifier users compared with 9.2% (17/184) in non-users (adjusted OR=0.88, 95% CI 0.43 to 1.80). In multivariate logistic regression analysis, duration of oxygen use (OR=1.61; 95% CI 1.18 to 2.20) and days of antimicrobial use (OR=1.62, 95% CI 1.34 to 1.94) were associated with higher risk of ND, whereas being breast fed (OR=0.40, 95% CI 0.17 to 0.93) and each day of hospital stay (OR=0.65, 95% CI 0.53 to 0.80) were protective factors. Faecal coliforms were isolated in 16% (27/169) of tested pacifiers, 77.8% of which had more than 100 000 CFU/ml. The probability of a child remaining free of an episode of diarrhoea up to the seventh day of hospitalisation in the ward was 91.2% (95% CI 87.7% to 94.9%). The log-rank test showed no statistical difference between pacifier users and non-users.
  
  
  CONCLUSIONS
  ND is a frequent healthcare-associated infection in paediatric wards, but the use of pacifiers during the stay in hospital does not seem to affect the incidence of ND in infants in many settings where the burden of diarrhoea is still high.
authors.affiliation: Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Gabriela Cunha Schechtman
authors.initials: GC
authors.lastname: Sette
authors.forename: Maria Júlia Gonçalves
authors.initials: MJ
authors.lastname: Mello
authors.forename: Jailson Barros
authors.initials: JB
authors.lastname: Correia
authors.forename: Ioram Schechtman
authors.initials: IS
authors.lastname: Sette
authors.forename: Gisélia Alves
authors.initials: GA
authors.lastname: Pontes da Silva
authors.forename: Luciane
authors.initials: L
authors.lastname: Soares de Lima