Nosocomial enterococcal infections in children

Objective: To identify factors that are associated with an increased risk o f nosocomial enterococcal infection in children. Methods: A matched case-control study was conducted between January 1989 an d July 1993 at the Children's National Medical Center, Washington DC, One c ontrol patient for each case was identified. Control patients did not have nosocomial enterococcal infections and were matched with cases on the basis of age and time of admission closest to the case within a three-month peri od, Data were collected from systematic review of patient medical records. One hundred and one study patients (cases) were matched with 101 control pa tients. A case was defined as a patient with enterococcal infection who met the Centers for Disease Control and Prevention criteria for nosocomial inf ection. Microbiology methods included isolation, identification, and antimi crobial susceptibility testing of enterococci from clinical specimens. Results: Risk factors associated with nosocomial enterococcal infections we re determined by multiple conditional logistic regression analyses of the c ases and controls. Factors identified were placement of a central line, gas trointestinal tract pathology and administration of multiple antimicrobial agents, The median duration of antimicrobial therapy prior to diagnosis of nosocomial enterococcal infection was approximately 1 week. Conclusion: The incidence of nosocomial enterococcal infections in children may be controlled by limiting the number of antimicrobial agents administe red to hospitalized high risk patients, The importance of our findings is r elevant in an era of increasing rates of antimicrobial resistance in nosoco mial enterococcal infections. (C) 2000 The British Infection Society.