RESUMEN
This prospective study aimed at determination of the incidence, pattern, and the organisms causing nosocomial infections [NIs] among general pediatric wards patients, and to identify the risk factors predictive of NI through a daily concurrent surveillance. All patients admitted for at least 72 hours to both medical and surgical divisions of a large teaching hospital in Alexandria [El Shatby Children's Hospital] from August 1[st], 2001 to April 30[th], 2002 were followed daily. The recorded informations included identifying data, clinical data, duration of admission, type and time of infection and information concerning surgical procedures especially type of operation and wound class. Specimens for culture differed according to site of infection. A total of 51 NIs were found among 801 patients with an overall NI rate of 6.4 per 100 admissions. There was no significant difference of NI rate among medical and surgical services. The most common infections were those of the urinary tract [47.8% of patients], wound site [17.4%], bloodstream [23.9%] and gastrointestinal tract [10.9%]. Lower respiratory tract [LRT] and skin infections were the least encountered infections [2.2% and 4.3% of patients respectively]. Two patients [4.3%] developed specific rashes; one of them was diagnosed as measles, and the other was chickenpox. Diagnosis of both cases was based on clinical criteria only. Eighty per cent of these infections were caused by the common gram-negative bacilli; Klebsiella, E. coli, proteus and pseudomonas aeruginosa in the order of frequency. Hospital-acquired diarrhea was caused exclusively by rotavirus. The isolated gram-negative bacilli showed marked resistance to the studied antibiotics. The main risk factors identified were the presence of underlying malnutrition, malignancy, and antibiotics and immunosuppressive therapy. Long duration of preoperative hospitalization, abdominal operation and dirty wound were identified as risk factors for surgical site infections. The use of catheters whether intravascular or urinary catheters and wound drains were also best predictors of NIs. This first surveillance study provided information on the current status and trends of NIs in a major teaching hospital. The results may contribute to the evaluation of infection control programs and the development of effective strategies in this hospital. Patients with a high risk of infection can be target of special preventive measure