NOSOCOMIAL INFECTIONS AMONG NEONATES IN HIGH-RISK NURSERIES IN THE UNITED-STATES

Background. Nosocomial infections result inconsiderable morbidity and mortality among neonates in high-risk nurseries (HRNs). Purpose. To ex amine the epidemiology of nosocomial infections among neonates in leve l III HRNs. Methods. Data were collected from 99 hospitals with HRNs p articipating in the National Nosocomial Infections Surveillance system , which uses standard surveillance protocols and nosocomial infection site definitions. The data included information on maternal acquisitio n of and risk factors for infection, such as device exposure, birth we ight category (less than or equal to 1000, 1001 through 1500, 1501 thr ough 2500, and >2500 g), mortality, and the relationship of the nosoco mial 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 comm on infection site, followed by the gastrointestinal and eye, ear, nose , and throat sites. The most common nosocomial pathogens among all neo nates were coagulase-negative staphylococci, Staphylococcus aureus, en terococci, Enterobacter sp, and Escherichia coli. Group B streptococci were associated with 46% of bloodstream infections that were maternal ly 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 cath eters. Conclusions. Bloodstream infections, the most frequent nosocomi al infections in all birth weight groups, should be a major focus of s urveillance and prevention efforts in HRNs. For bloodstream infections , stratification of surveillance data by maternal acquisition will hel p focus prevention efforts for group B streptococci outside the HRN. W ithin the nursery, bloodstream infection surveillance should focus on umbilical or central intravenous catheter use, a major risk factor for infection.