title: Five-year prospective surveillance of nosocomial bloodstream infections in an Estonian paediatric intensive care unit.
abstract: BACKGROUND
  Few studies provide rates of nosocomial bloodstream infections (BSIs) in mixed neonatal and paediatric intensive care units (PICUs).
  
  
  OBJECTIVE
  To determine the rate, pathogens and outcome of BSIs in an Estonian PICU.
  
  
  METHODS
  Data were collected prospectively from 1st January 2004 to 31st December 2008 in the PICU of Tartu University Hospital. The definition criteria of the US Centers for Disease Control and Prevention were applied for the diagnosis of laboratory-confirmed BSI.
  
  
  RESULTS
  A total of 126 episodes of BSI were identified in 89 patients (74 neonates, eight infants, seven patients aged >1 year). Among neonates 42 (57%) had birth weight <1000 g. The overall incidence of BSI was 9.2 per 100 admissions, incidence density 12.8 per 1000 patient-days. Primary BSI was diagnosed in 92 episodes. Central line (CL)-associated BSI incidence density for neonates was 8.6 per 1000 CL-days with the highest incidence (27.4) among neonates with extremely low birth weight. The most common pathogens were coagulase-negative staphylococci (43%) and Serratia marcescens (14%). Resistance to meticillin was detected in four out of seven S. aureus isolates (all were part of an outbreak) and 23% of Enterobacteriaceae were extended spectrum beta-lactamase (ESBL)-producing strains. Overall case-fatality rate was 10%.
  
  
  CONCLUSIONS
  We observed higher rates of BSIs in our mixed PICU than reported previously. High levels of antimicrobial resistance were detected. Future research should focus on the effects of infection control measures to prevent outbreaks and to decrease incidence of CL-associated BSI.
authors.affiliation: Department of Infection Control, Tartu University Hospital, Tartu, Estonia. Electronic address: Piret.Mitt@kliinikum.ee.
authors.forename: P
authors.initials: P
authors.lastname: Mitt
authors.affiliation: Department of Paediatric Intensive Care Unit, Tartu University Hospital, Tartu, Estonia.
authors.forename: T
authors.initials: T
authors.lastname: Metsvaht
authors.affiliation: Department of Infection Control, Tartu University Hospital, Tartu, Estonia.
authors.forename: V
authors.initials: V
authors.lastname: Adamson
authors.affiliation: Department of Infection Control, Tartu University Hospital, Tartu, Estonia.
authors.forename: K
authors.initials: K
authors.lastname: Telling
authors.affiliation: Department of Microbiology, University of Tartu, Tartu, Estonia.
authors.forename: P
authors.initials: P
authors.lastname: Naaber
authors.affiliation: Department of Microbiology, University of Tartu, Tartu, Estonia.
authors.forename: I
authors.initials: I
authors.lastname: Lutsar
authors.affiliation: Department of Infection Control, Tartu University Hospital, Tartu, Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Maimets
mesh_terms: D000818:Animals; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D025141:Drug Resistance, Fungal; D062665:Epidemiological Monitoring; D004957:Estonia; D005260:Female; D005658:Fungi / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology
keywords: Child; Infant; Nosocomial infection; Paediatric intensive care unit; Sepsis