Clinical and microbiological study of nosocomial infections in the paediatric intensive care unit [PICU] in Mansoura university children's hospital

ABSTRACT

Nosocomial infections result in considerably high mortality and morbidity rates, especially among paediatric patients. This is a prospective study conducted to study the incidence of NI including NIR, main infection sites, and common microorganisms and the risk factors in PICU in Mansoura University Children's Hospital. The study enrolled children admitted to PICU for ?48 hrs from January 2004 to December 2005 inclusive. Nosocomial infections were diagnosed according to the CDC definitions for NIs. Risk factors such as age, length of stay and risk of mortality score were studied. Isolation, identification and antimicrobial susceptibility were carried out. Biochemical reactions were further done to all isolated bacteria by standard routine methods. An outbreak of UTI due do Candida species was detected and RFLP was used for typing and tracing of the source of infection. Overall NIR was 78 episodes per 1000 PICU days and patient infection rate was 16.9%. NIs were higher among younger children as well as those having higher length of stay and risk of mortality. Mortality was higher in the group with NI [36% vs. 19%]. Klebsiella was the most common isolate [19.1%] followed by staphylococcus aureus [12.2%], CoNS [11.8%], E-coli [11.4%], pseudomonas [11%], Candida spp. [9.8%], MRSA [6.5%]. Of all infections, respiratory tract infections comprised 30.9%, blood stream infection 27.3%, IV catheter related infection 23.1%, and UTI 16.7%. Imipenem was the most effective antibiotic against Gram negative bacteria. Ampicillin/sulbactam and amoxicillin clavulonate were effective against Gram positive isolates. The future challenge is to minimize NI while limiting the emergence of antibiotic resistant organisms with optimal cost effective care