RESUMO
OBJECTIVE: The purpose of this study was to determine the prevalence of nosocomial infections, associated risk factors, microbiology, use of antibiotics, and associated mortality among hospitalized children. MATERIAL AND METHODS: A 1-day prevalence survey was conducted among 1,183 children hospitalized in a nationwide network of 21 public hospitals caring for children. To attain consistency between hospitals, CDC nosocomial infection definitions were used. Adjusted relative odds of bacteremia were estimated using logistic regression analysis. RESULTS: The prevalence of nosocomial acquired infection was 9.8% (CI 95%, 8.1-11.6). The more prevalent infections were pneumonia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%). The main microorganism isolated in blood cultures drown from patients with nosocomial infection was K. pneumoniae (31%). The prevalence of antibiotics use was 49% with substantial variation between hospitals (range 3-83%). Using logistic regression analysis, four factors were independently associated with the risk of nosocomial infection: central venous catheters (OR 3.3; CI 95% 1.0-5.9), total parenteral nutrition (OR 2.1; CI 95% 1.0-4.5) mechanical ventilation (OR 2.3; CI 95% 1.2-4.1), and low birth weight (OR 2.6; CI 95% 1.0-6.8). The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected children (OR 2.6; CI 95% 1.3-5.1). CONCLUSIONS: This rapid assessment survey using a standard methodology allows to document the prevalence of nosocomial infections in children. The results were used to develop targeted programs on central catheters and mechanical ventilation aimed to reduce bacteremia/sepsis and pneumonia, two nosocomial infections characterized by high prevalence and mortality.
Assuntos
Infecção Hospitalar/epidemiologia , Adolescente , Fatores Etários , Cateterismo/efeitos adversos , Criança , Pré-Escolar , Infecção Hospitalar/etiologia , Infecção Hospitalar/mortalidade , Estudos Transversais , Coleta de Dados , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , México/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Respiração Artificial/efeitos adversos , Fatores de RiscoRESUMO
Introducción. las infecciones nosocomiales (IN) por bacilos gramnegativos no fermentadores (BGNNF) son un problema creciente, por lo que es importante el conocimiento de sus características epidemiológicas, así como su patrón de resistencia. Material y métodos. Se realizó un estudio descriptivo que incluyó 52 episodios de infecciones nosocomiales por BGNNF durante 1994; los patrones de resistencia antimicrobiana se determinaron por la técnica de Kirby-Bauer. Resultados. Se encontró que de las 870 infecciones nosocomiales reportadas durante 1994, 52 correspondieron a BGNNF (5.9 por ciento). Los principales agentes involucrados fueron Pseudomona aeruginosa en 45 casos, seguido de B. cepacia en 4, P. fluorescens en 3 y Acinetobacter spp. en 3 casos. Las neumonías representaron el principal tipo de infección en el 34 por ciento de los casos. Se encontró una resistencia importante para antibióticos de primera elección. Conclusiones. Los BGNNF, principalmente Pseudomonas, son causa frecuente de neumonía nosocomial. Dado su patrón de resistencia, pueden ser de difícil manejo clínico. Es necesario diseñar un estudio para determinar su pronóstico.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Resistência Microbiana a Medicamentos , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Negativas/patogenicidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , MéxicoRESUMO
Candida is an increasing problem as a causal agent of nosocomial infection in neonates and infants. We report 15 cases of infective endocarditis caused by Candida spp treated at the Hospital Infantil de Mexico between 1980 and 1991. The diagnosis of endocarditis was established by the identification of Candida in at least two blood cultures and echocardiographic assessment. From 110 cases of systemic candidiasis during the eleven years period of study, fifteen patients presented endocarditis (13.6%), all had a central venous catheter. Three had antecedent of congenital heart disease. Candida isolation was obtained an average of 28 days after admission. The major clinical findings were: fever in 13 patients, respiratory distress and cardiac murmurs observed in nine respectively. Thrombocytopenia was present in eight children. The echocardiographic evaluation showed vegetations located in the superior vena cava in six, right atrium in five, tricuspid valve in two, inferior vena cava and right ventricle in one respectively. Three cases were subjected to surgical treatment. Nine patients died for a case fatality rate of 60%. The echocardiographic evaluation practiced in all patients with suspicion of systemic candidiasis is critical for the prognosis. The identification of endocardiac involvement coupled with the opportune administration of antifungal therapy and surgical treatment may improved the survival.