Nosocomial Infections Among Neonates in High-risk Nurseries in the United States

¹ Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Address correspondence to: Robert P. Gaynes, MD, Hospital Infections Program, National Center for Infectious Diseases, Mail Stop E-55, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333

Background. Nosocomial infections result in considerable morbidity and mortality among neonates in high-risk nurseries (HRNs).

Purpose. To examine the epidemiology of nosocomial infections among neonates in level III HRNs.

Methods. Data were collected from 99 hospitals with HRNs participating in the National Nosocomial Infections Surveillance system, which uses standard surveillance protocols and nosocomial infection site definitions. The data included information on maternal acquisition of and risk factors for infection, such as device exposure, birth weight category (1000, 1001 through 1500, 1501 through 2500, and >2500 g), mortality, and the relationship of the nosocomial infection to death.

Results. From October 1986 through September 1994, these hospitals submitted data on 13 179 nosocomial infections. The bloodstream was the most frequent site of nosocomial infection in all birth weight groups. Nosocomial pneumonia was the second most common infection site, followed by the gastrointestinal and eye, ear, nose, and throat sites. The most common nosocomial pathogens among all neonates were coagulase-negative staphylococci, Staphylococcus aureus, enterococci, Enterobacter sp, and Escherichia coli. Group B streptococci were associated with 46% of bloodstream infections that were maternally acquired; coagulase-negative staphylococci were associated with 58% of bloodstream infections that were not maternally acquired, most of which (88%) were associated with umbilical or central intravenous catheters.

Conclusions. Bloodstream infections, the most frequent nosocomial infections in all birth weight groups, should be a major focus of surveillance and prevention efforts in HRNs. For bloodstream infections, stratification of surveillance data by maternal acquisition will help focus prevention efforts for group B streptococci outside the HRN. Within the nursery, bloodstream infection surveillance should focus on umbilical or central intravenous catheter use, a major risk factor for infection.

This article has been cited by other articles:

				C. L. Pessoa-Silva, S. Hugonnet, R. Pfister, S. Touveneau, S. Dharan, K. Posfay-Barbe, and D. Pittet Reduction of Health Care Associated Infection Risk in Neonates by Successful Hand Hygiene Promotion Pediatrics, August 1, 2007; 120(2): e382 - e390. [Abstract] [Full Text] [PDF]

				E. Foglia, M. D. Meier, and A. Elward Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients Clin. Microbiol. Rev., July 1, 2007; 20(3): 409 - 425. [Abstract] [Full Text] [PDF]

				J. P. Cimiotti, J. Haas, L. Saiman, and E. L. Larson Impact of Staffing on Bloodstream Infections in the Neonatal Intensive Care Unit Arch Pediatr Adolesc Med, August 1, 2006; 160(8): 832 - 836. [Abstract] [Full Text] [PDF]

				M. Khashu, H. Osiovich, D. Henry, A. A. Khotani, A. Solimano, and D. P. Speert Persistent Bacteremia and Severe Thrombocytopenia Caused by Coagulase-Negative Staphylococcus in a Neonatal Intensive Care Unit Pediatrics, February 1, 2006; 117(2): 340 - 348. [Abstract] [Full Text] [PDF]

				M. J. Bizzarro, C. Raskind, R. S. Baltimore, and P. G. Gallagher Seventy-Five Years of Neonatal Sepsis at Yale: 1928-2003 Pediatrics, September 1, 2005; 116(3): 595 - 602. [Abstract] [Full Text] [PDF]

				D. M. Zerr Alcohol Hand Rub: A Simple Solution in Search of Champions Arch Pediatr Adolesc Med, May 1, 2005; 159(5): 502 - 503. [Full Text] [PDF]

				A. Ronnestad, T. G. Abrahamsen, S. Medbo, H. Reigstad, K. Lossius, P. I. Kaaresen, T. Egeland, I. E. Engelund, L. M. Irgens, and T. Markestad Late-Onset Septicemia in a Norwegian National Cohort of Extremely Premature Infants Receiving Very Early Full Human Milk Feeding Pediatrics, March 1, 2005; 115(3): e269 - e276. [Abstract] [Full Text] [PDF]

				C. M. Healy, D. L. Palazzi, M. S. Edwards, J. R. Campbell, and C. J. Baker Features of Invasive Staphylococcal Disease in Neonates Pediatrics, October 1, 2004; 114(4): 953 - 961. [Abstract] [Full Text] [PDF]

				N. R. Payne, J. H. Carpenter, G. J. Badger, J. D. Horbar, and J. Rogowski Marginal Increase in Cost and Excess Length of Stay Associated With Nosocomial Bloodstream Infections in Surviving Very Low Birth Weight Infants Pediatrics, August 1, 2004; 114(2): 348 - 355. [Abstract] [Full Text] [PDF]

				W. H. Edwards, J. M. Conner, R. F. Soll, and for the Vermont Oxford Network Neonatal Skin Care The Effect of Prophylactic Ointment Therapy on Nosocomial Sepsis Rates and Skin Integrity in Infants With Birth Weights of 501 to 1000 g Pediatrics, May 1, 2004; 113(5): 1195 - 1203. [Abstract] [Full Text] [PDF]

				A. Jain, I. Roy, M. K. Gupta, M. Kumar, and S. K. Agarwal Prevalence of extended-spectrum {beta}-lactamase-producing Gram-negative bacteria in septicaemic neonates in a tertiary care hospital J. Med. Microbiol., May 1, 2003; 52(5): 421 - 425. [Abstract] [Full Text] [PDF]

				H. W. Kilbride, R. Powers, D. D. Wirtschafter, M. B. Sheehan, D. S. Charsha, M. LaCorte, N. Finer, and D. A. Goldmann Evaluation and Development of Potentially Better Practices to Prevent Neonatal Nosocomial Bacteremia Pediatrics, April 1, 2003; 111(4): e504 - 518. [Abstract] [Full Text] [PDF]

				H. W. Kilbride, D. D. Wirtschafter, R. J. Powers, and M. B. Sheehan Implementation of Evidence-Based Potentially Better Practices to Decrease Nosocomial Infections Pediatrics, April 1, 2003; 111(4): e519 - 533. [Abstract] [Full Text] [PDF]

				R. A. Polin and L. Saiman Nosocomial Infections in the Neonatal Intensive Care Unit NeoReviews, March 1, 2003; 4(3): e81 - 89. [Full Text] [PDF]

				D Isaacs A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2003; 88(2): F89 - F93. [Abstract] [Full Text] [PDF]

				L. G. Rubin, P. J. Sanchez, J. Siegel, G. Levine, L. Saiman, and W. R. Jarvis Evaluation and Treatment of Neonates With Suspected Late-Onset Sepsis: A Survey of Neonatologists' Practices Pediatrics, October 1, 2002; 110(4): e42 - 42. [Abstract] [Full Text] [PDF]

				B. J. Stoll, N. Hansen, A. A. Fanaroff, L. L. Wright, W. A. Carlo, R. A. Ehrenkranz, J. A. Lemons, E. F. Donovan, A. R. Stark, J. E. Tyson, et al. Late-Onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network Pediatrics, August 1, 2002; 110(2): 285 - 291. [Abstract] [Full Text] [PDF]

				W. C. Van Der Zwet, Y. J. Debets-Ossenkopp, E. Reinders, M. Kapi, P. H. M. Savelkoul, R. M. Van Elburg, K. Hiramatsu, and C. M. J. E. Vandenbroucke-Grauls Nosocomial Spread of a Staphylococcus capitis Strain with Heteroresistance to Vancomycin in a Neonatal Intensive Care Unit J. Clin. Microbiol., July 1, 2002; 40(7): 2520 - 2525. [Abstract] [Full Text] [PDF]

				N. Zafar, C. M. Wallace, P. Kieffer, P. Schroeder, M. Schootman, and A. Hamvas Improving Survival of Vulnerable Infants Increases Neonatal Intensive Care Unit Nosocomial Infection Rate Arch Pediatr Adolesc Med, October 1, 2001; 155(10): 1098 - 1104. [Abstract] [Full Text] [PDF]

				M. Foca, K. Jakob, S. Whittier, P. D. Latta, S. Factor, D. Rubenstein, and L. Saiman Endemic Pseudomonas aeruginosa Infection in a Neonatal Intensive Care Unit N. Engl. J. Med., September 7, 2000; 343(10): 695 - 700. [Abstract] [Full Text] [PDF]

				P. Villari, C. Sarnataro, and L. Iacuzio Molecular Epidemiology of Staphylococcus epidermidis in a Neonatal Intensive Care Unit over a Three-Year Period J. Clin. Microbiol., May 1, 2000; 38(5): 1740 - 1746. [Abstract] [Full Text]

				J. R. Campbell, E. Zaccaria, and C. J. Baker Systemic Candidiasis in Extremely Low Birth Weight Infants Receiving Topical Petrolatum Ointment for Skin Care: A Case-Control Study Pediatrics, May 1, 2000; 105(5): 1041 - 1045. [Abstract] [Full Text]

				R. J. Schanler Overview: The Clinical Perspective J. Nutr., February 1, 2000; 130(2): 417 - 417. [Full Text]

				M. J. Richards, J. R. Edwards, D. H. Culver, R. P. Gaynes, and the National Nosocomial Infections Surveillance Sy Nosocomial Infections in Pediatric Intensive Care Units in the United States Pediatrics, April 1, 1999; 103(4): 39e - 39. [Abstract] [Full Text]

				D. J. Weber, R. Raasch, and W. A. Rutala Nosocomial Infections in the ICU: The Growing Importance of Antibiotic-Resistant Pathogens Chest, March 1, 1999; 115(suppl_1): 34S - 41S. [Abstract] [Full Text] [PDF]

				I.-S. Park, C.-H. Lin, and C. T. Walsh Bacterial resistance to vancomycin: Overproduction, purification, and characterization of VanC2 from Enterococcus casseliflavus as a D-Ala-D-Ser ligase PNAS, September 16, 1997; 94(19): 10040 - 10044. [Abstract] [Full Text] [PDF]

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 1996 American Academy of Pediatrics. All rights reserved.