Pediatric Intensivist, Master in Medicine, Instituto Nacional de Salud del Niño and Universidad Nacional Federico Villarreal, Lima, Peru.
BMC Pediatr. 2010 Sep 10;10:66. doi: 10.1186/1471-2431-10-66.
Nosocomial Infections (NI) are a frequent and relevant problem. The purpose of this study was to determine the epidemiology of the three most common NI in a Pediatric Intensive Care Unit from a developing country.
We performed a prospective study in a single Pediatric Intensive Care Unit during 12 months. Children were assessed for 3 NI: bloodstream infections (BSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI), according to Center for Disease Control criteria. Use of devices (endotracheal tube [ETT], central venous catheter [CVC] and urinary catheter [UC]) was recorded.
Four hundred fourteen patients were admitted; 81 patients (19.5%) developed 85 NIs. Density of incidence of BSI, VAP and UTI was 18.1, 7.9 and 5.1/1000 days of use of CVC, ETT and UC respectively. BSI was more common in children with CVCs than in those without CVCs (20% vs. 4.7%, p < 0.05). Candida spp. was the commonest microorganism in BSI (41%), followed by Coagulase-negative Staphylococcus (17%). Pseudomonas (52%) was the most common germ for VAP and Candida (71%) for UTI. The presence of NI was associated with increased mortality (38.2% vs. 20.4% in children without NI; p < 0.001) and the median length of ICU stay (23 vs. 6 days in children without NI; p < 0.001). Children with NI had longer average hospital stay previous to diagnosis of this condition (12.3 vs. 6 days; p < 0.001).
One of every 5 children acquires an NI in the PICU. Its presence was associated with increased mortality and length of stay. At the same time a longer stay was associated with an increased risk of developing NI.
医院获得性感染（NI）是一个常见且重要的问题。本研究的目的是确定发展中国家儿科重症监护病房（PICU）中三种最常见的 NI 的流行病学情况。
我们在一个儿科重症监护病房进行了为期 12 个月的前瞻性研究。根据疾病控制中心的标准，对儿童进行了三种 NI 的评估：血流感染（BSI）、呼吸机相关性肺炎（VAP）和尿路感染（UTI）。记录了使用设备（气管插管[ETT]、中心静脉导管[CVC]和导尿管[UC]）的情况。
共有 414 名患儿入院，81 名患儿（19.5%）发生了 85 例 NI。BSI、VAP 和 UTI 的发病率密度分别为每 1000 天使用 CVC、ETT 和 UC 时 18.1、7.9 和 5.1 例。与未使用 CVC 的患儿相比，使用 CVC 的患儿更易发生 BSI（20%比 4.7%，p<0.05）。BSI 中最常见的微生物是念珠菌属（41%），其次是凝固酶阴性葡萄球菌（17%）。VAP 中最常见的病原体是假单胞菌（52%），UTI 中最常见的病原体是念珠菌（71%）。NI 的存在与死亡率增加（NI 患儿为 38.2%，无 NI 患儿为 20.4%；p<0.001）和 ICU 住院时间延长（NI 患儿为 23 天，无 NI 患儿为 6 天；p<0.001）相关。诊断 NI 前，NI 患儿的平均住院时间较长（12.3 天比 6 天；p<0.001）。
每 5 名患儿中就有 1 名在 PICU 中发生 NI。其存在与死亡率和住院时间延长相关。同时，住院时间延长与发生 NI 的风险增加相关。
