Nosocomial pediatric bacteremia: the role of intravenous set contamination in developing countries.

OBJECTIVE

To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates.

DESIGN

Cultures of injection ports and infusate during 26 visits to 4 hospitals.

SETTING

Four public general pediatric hospitals in Mexico City with substandard care practices.

PATIENTS

Hospitalized pediatric patients receiving intravenous solutions.

RESULTS

Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%).

CONCLUSION

These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.