Nosocomial bacteremia in neonates related to poor standards of care
Nosocomial bacteremia in neonates related to poor standards of care
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DOI：
10.1097/01.inf.0000172150.66717.92
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发表时间：
2005-08-01
影响因子：
3.6
通讯作者：
Ponce-De-Leon, S
中科院分区：
文献类型：
--
作者：
Macias, AE;Munoz, JM;Ponce-De-Leon, S
Background: In developing countries, intravenous liquids are mixed and administered by nurses, sometimes under suboptimal infection control conditions. We hypothesized that outbreaks of infusate-associated neonatal bacteremias are common, and we evaluated whether they can be detected by vigilant microbiologic surveillance of infusates.Methods: We studied intravenous infusates administered to neonates in a Mexican hospital where mixtures of infusates were prepared in hospital wards. The study was performed in 3 stages: stage 1, initial culturing of in-use infusates under basal conditions; stage 2, prospective culturing during a cluster of clinical sepsis; and stage 3, final culturing once the outbreak was controlled.Results: In stage 1, 68 infusates were sterile, and I was contaminated with Staphylococcus aureus (1.45%), from 23 patients. In stage 2, of 182 infusates from 39 patients, 51 infusates (28%) were contaminated with Gram-negative rods. On the first day of stage 2, 11 of 15 infusates were contaminated with the same strain of Klebsiella pneumoniae, which continued to appear for 26 days. Another 4 strains of Gram-negative rods were also isolated during stage 2. The association between contaminated infusate and death was significant (odds ratio, 9.4; 95% confidence interval, 2-44.3; P < 0.001). Mixtures made by nurses were more likely contaminated than commercial preparations (odds ratio, 3.1; 95% confidence interval, 1.1-8.5; P = 0.037). In stage 3, there were 42 sterile infusates from 22 patients.Conclusions: Our study suggests that poor standards of care common in hospitals from developing countries sometimes result in outbreaks of sepsis and death for newborn patients.
