Nosocomial bloodstream infections in pediatric wards.

Background. - Nosocomial bloodstream infections in pediatrics are an import ant cause of morbidity and mortality. To identify pathogens causing nosocom ial bloodstream infections, evaluate associated risk factors and take preve ntive measures, we conducted a prospective study from January 1995 to Decem ber 1995 at Saint-Vincent-de-Paul Hospital (Paris). Patients and results. - All patients hospitalized more than 48 hours were i ncluded in the study. During this period, we recorded 21 bloodstream infect ions in 20 children. The incidence rate of nosocomial bloodstream infection was 1/1,000 admissions. Sixteen children were hospitalized in surgery, thr ee in medical intensive care unit; the median day onset of infection was ap proximately 20 days. Recorded risk factors were: surgery invasive procedure s, central cathetarization, bladder catheters, parenteral nutrition, device , endotracheal tube, antibiotic therapy before infection. The number of ris k factors ranged from zero to sir per patient. The most common isolated pat hogens were in ten cases Gram positive cocci: five methicillin-sensible Sta phylococcus aureus, four methicillin-resistant coagulase-negative staphyloc occi and one Streptococcus milleri. Other bacteria were seven enterobacteri a, three Pseudomonas sp and three Candida sp. In II cases, the same bacteri a as in bloodstream infection could be found: in three urine samples, in tw o tracheal samples, in two gastro-intestinal samples, two puncture sites on e device, and one umbilical catheter. Conclusion. - In our study, 6.2% of positive blood culture were due to a no socomial infection. We confirm the importance of Gram positive cocci, and p articularly of methicillin-resistant coagulase negative staphylococci. (C) 1998 Elsevier, Paris.