Nosocomial infections in children: Prevalence survey in 21 public hospitals in Mexico.

Objective. The purpose of this study was to determine the prevalence of nos ocomial infections, associated risk factors, microbiology, use of antibioti cs, and associated mortality among hospitalized children. Material and meth ods. A I-day prevalence survey was conducted among 1183 children hospitaliz ed in a nationwide network of 21 public hospitals caring for children. To a ttain consistency between hospitals, CDC nosocomial infection definitions w ere used. Adjusted relative odds of bacteremia were estimated using logisti c regression analysis. Results. The prevalence of nosocomial acquired infec tion was 9.8% (CI 95%, 8.1-11.6). The more prevalent infections were pneumo nia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%). The m ain microorganism isolated in blood cultures drown from patients with nosoc omial infection was K. penumoniae (31%). The prevalence of antibiotics use was 49% with substantial variation between hospitals (range 3-83%). Using l ogistic regression analysis, four factors were independently associated wit h the risk of nosocomial infection: central venous catheters (OR 3.3; CI 95 % 1.0-5.9), total parenteral nutrition (OR 2.1; CI 95%1.0-4.5) mechanical v entilation (OR 2.3; CI 95% 1.2-4.1), and low birth weight (OR 2.6; CI 95% 1 .0-6.8). The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected chi ldren (OR 2.6; CI 95% 1.3-5.1). Conclusions, This rapid assessment survey u sing a standard methodology allows to document the prevalence of nosocomial infections in children. The results were used to develop targeted programs on central catheters and mechanical ventilation aimed to reduce bacteremia /sepsis and pneumonia, two nosocomial infections characterized by high prev alence and mortality.