Nosocomial infections in pediatric patients: A European, multicenter prospective study

OBJECTIVES: To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children. DESIGN: 6-month prospective study with periodic chart review during hospita lization using a uniform prospective questionnaire in each unit, analyzed a t a coordinating center. SETTING: 20 units in eight European countries: 5 pediatric intensive care u nits (PICUs), 7 neonatal units, 2 hematology oncology units, 8 general pedi atric units. PARTICIPANTS: All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria. RESULTS: The overall incidence of NI was 2.5%, ranging from 1% in general p ediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-n egative bacilli, 37%; gram-positive cocci. 31%), Candida for 9%, and viruse s for 22% of cases. The proportion of lower respiratory tract infections wa s 13% in general pediatric units and 53% in PICUs. Bloodstream infections w ere most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negative Staphylococcus (CNS) was the main pathogen. Eleven percent of NI were urinary tract infec tions. Gastrointestinal infections were most commonly viral and accounted f or 76% of NIs in general pediatric units. The prevalence of antimicrobial r esistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% of Staphylococcus aureus and 89% of CNS were methicillin-resis tant, and 37.5% of Klebsiella pneumoniae had an extended-spectrum beta-lact amase. Mortality due to NI was 10% in PICUs and 17% in neonatal units. CONCLUSIONS: We found large differences in NI frequency and microbial epide miology in this European study Viruses were the main pathogens in general p ediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Cl inical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.