Pérez-González Luis Fernando, Ruiz-González Juana María, Noyola Daniel E
Unidad de Vigilancia Epidemiologica, Hospital Central, San Luis Potosi, Mexico.
Infect Control Hosp Epidemiol. 2007 Apr;28(4):418-22. doi: 10.1086/513025. Epub 2007 Mar 9.
To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital.
Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared.
A public general hospital in San Luis Potosi, Mexico.
Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection.
Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel.
There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions. Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.
描述一家综合医院儿童医院获得性血流感染的发生率及病因。
回顾1991 - 2005年期间在儿童中检测到的医院获得性血流感染情况。通过主动监测前瞻性收集数据。比较年度感染率。
墨西哥圣路易斯波托西的一家公立综合医院。
15岁以下入住儿科病房并接受医院感染前瞻性监测的儿童。
在15年研究期间采取的降低医院获得性感染发生率的措施包括建立医院获得性感染主动监测、加强对手卫生建议的依从性、减少病房拥挤程度、制定静脉导管和溶液管理指南、在层流通风橱下配制肠外营养和静脉溶液以及增加护理人员。
在29273名受试者中检测到868例医院获得性血流感染（总体发生率为每100次出院2.94例）。新生儿重症监护病房收治的儿童感染率最高，学龄病房和传染病病房收治的儿童感染率最低。所有病房的医院获得性菌血症发生率均显著下降。最常分离出的病原体是肺炎克雷伯菌、念珠菌属和凝固酶阴性葡萄球菌。革兰氏阴性菌血流感染儿童的死亡率较高（45.2%），革兰氏阳性菌感染儿童的死亡率较低（19.2%）。结论：在过去15年中，我院医院获得性血流感染发生率有所下降，但仍导致显著的死亡率。有必要继续努力降低血流感染的发生率和死亡率。
