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Improving Survival of Vulnerable Infants Increases Neonatal Intensive Care Unit Nosocomial Infection Rate
Nagma Zafar, MD;
Colleen M. Wallace, MD;
Patricia Kieffer, RN;
Patricia Schroeder, RN;
Mario Schootman, PhD;
Aaron Hamvas, MD
Arch Pediatr Adolesc Med. 2001;155:1098-1104.
Objective To determine the factors associated with an increasing rate of nosocomial
infections in infants with very low birth weights.
Methods Retrospective review of clinical and nosocomial infection databases
for all infants with birth weights of 1500 g or less admitted to an academic
neonatal intensive care unit between January 1, 1991, and December 31, 1997
(N = 1184). Two study periods were compared: 1991-1995 and 1996-1997.
Results Among the 1085 infants who survived beyond 48 hours, the proportion
who developed nosocomial infections increased from 22% to 31% (P = .001) and the infection rate increased from 0.5 to 0.8 per 100
patient-days (P<.001) during the period from 1996
to 1997. In that same period, the median duration of indwelling vascular access
increased from 10 to 16 days (P<.001), and the
median duration of mechanical ventilation increased from 7 to 12 days (P<.001). Although the device-specific rate of bloodstream
or respiratory infections did not change, the increase in infections was directly
attributable to the increasing proportion of infants who required these devices.
In both study periods, the peak incidence of initial infection occurred between
10 and 20 days of age. For the entire sample, proportional hazard models identified
birth weight, duration of vascular access, and postnatal corticosteroid exposure
as significant contributors to the risk of infection.
Conclusions The increasing number of technology-dependent infants was the primary
determinant in the increase of nosocomial infections. Because these infections
occur in a small proportion of infants, understanding the host factors that
contribute to this vulnerability is necessary to decrease nosocomial infections
in neonatal intensive care units.
From the Edward Mallinckrodt Department of Pediatrics (Drs Zafar, Wallace,
and Hamvas and Mss Kieffer and Schroeder), Washington University School of
Medicine and St Louis Children's Hospital; and the Department of Internal
Medicine (Dr Schootman), Washington University School of Medicine, St Louis,
Mo.
Corresponding author: Aaron Hamvas, MD, Division of Newborn Medicine,
St Louis Children's Hospital, One Children's Place, St Louis, MO 63110 (e-mail: hamvas{at}kids.wustl.edu).
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