Nosocomial infections in pediatric intensive care units in the United States

Objectives. To describe the epidemiology of nosocomial infections in pediat ric intensive care units (ICUs) in the United States. Background. Patient and ICU characteristics in pediatric ICUs suggest the p attern of nosocomial infections experienced may differ from that seen in ad ult ICUs. Methods. Data were collected between January 1992 and December 1997 from 61 pediatric ICUs in the United States using the standard surveillance protoc ols and nosocomial infection site definitions of the National Nosocomial In fections Surveillance System's ICU surveillance component. Results. Data on 110 709 patients with 6290 nosocomial infections were anal yzed. Primary bloodstream infections (28%), pneumonia (21%), and urinary tr act infections (15%) were most frequent and were almost always associated w ith use of an invasive device. Primary blood-stream infections and surgical site infections were reported more frequently in infants aged 2 months or less as compared with older children. Urinary tract infections were reporte d more frequently in children >5 years old compared with younger children. Coagulase-negative staphylococci (38%) were the most common bloodstream iso lates, and aerobic Gram-negative bacilli were reported in 25% of primary bl oodstream infections. Pseudomonas aeruginosa (22%) was the most common spec ies reported from pneumonia and Escherichia coli (19%), from urinary tract infections. Enterobacter spp. were isolated with increasing frequency from pneumonia and were the most common Gram-negative isolates from bloodstream infections. Device-associated infection rates for bloodstream infections, p neumonia, and urinary tract infections did not correlate with length of sta y, the number of hospital beds, or season. Conclusions. In pediatric ICUs, bloodstream infections were the most common nosocomial infection. The distribution of infection sites and pathogens di ffered with age and from that reported from adult ICUs. Device-associated i nfection rates were the best rates currently available for comparisons betw een units, because they were not associated with length of stay, the number of beds in the hospital, or season.