One year study of bacterial and fungal nosocomial infections among patients in pediatric intensive care unit (PICU) in Alexandria

A 1-year prospective and observational study included all admissions (n=216) until 48 h after discharge to Alexandria PICU between first of May 2003 and end of April 2004. Cultures for bacteria and fungi and antibiotic sensitivity tests (19 antibiotic using Bauer-Kirby disc diffusion method) were obtained (blood, stool, urine and cerebrospinal fluid, if needed) and repeated on suspicion of NIs. All cannulae, endotracheal tube (ET) aspirates and tips, nasogastric tubes and different catheters were cultured. All PICU health care workers (HCWs) were subjected to throat and under-finger nails cultures as well as inanimate objects, both on bimonthly basis. The referral place (ward or emergency), PRISM III score, length of stay (LOS) and fate were recorded. Amongst those patients whose age ranged from 1 to 23 months, 23 per cent had NIs with infection rates of 40/1000 days. Significantly high rates of mortality, LOS and PRISM III score were encountered among patients with NIs (52 per cent vs 30 per cent; 9.4 +/- 4.8 vs 5.4 +/- 2.2 days; 14.4 +/- 7 vs 11.8 +/- 6 respectively). The descending order of frequency of NIs was blood stream infection (BSI) (47 per cent), urinary tract infection (UTI) (28 per cent), ventilator-associated pneumonia (VAP) (16 per cent) and meningitis (9 per cent). Gr-ve bacilli accounted for 76.7 per cent; Gr+ve cocci 13.3 per cent (with satisfactory sensitivity to cefepime, imipenem and meropenem) and Candida albicans 10 per cent of all NIs. The rate of NIs/1000 device days were: 18.7 per cent for BSI, 10.9 per cent for VAP and 25.5 per cent for UTI. Vulnerable age groups were > 6 m for VAP and < 6 m for meningitis. Multiple logistic regression analysis identified LOS, PRISM III score and referral from wards a predictors of NI acquisition (odd ratio and 95 per cent confidence interval: 1.537, 1.423-1.659; 1.073, 1.041-1.105 and 0.269, 0.178-0.406 respectively). Bimonthly cultures for HCWs isolated coagulase-ve Staphylococci, while inanimate objects isolated diphtheroids and Candida albicans. Conclusion: NIs rate was high (23 per cent) mainly due to severity of condition on admission as shown by high PRISM III score value, the high PRISM III score, LOS and referral from wards were predictors of acquisition of NIs and there is a high incidence of Candida albicans infection (10 per cent of NIs).