Unique epidemiology of nosocomial urinary tract infection in children

Background: Nosocomial urinary tract infection (NUTI) occurs with varying f requency in children and is thought to be associated with urethral instrume ntation. In response to changing infection control resources at our facilit y, we reviewed NUTI to determine whether the frequency of NUTI, associated complications, or presence of a remediable risk factor (instrumentation) ju stified ongoing routine infection control surveillance. Methods: Prospective surveillance was conducted on all wards 8 months per y ear from January 1991 through December 1997 by an infection control nurse c oordinator. NUTI was defined by laboratory evidence according to Center for Disease Control and Prevention definitions and detected 48 hours after adm ission. Urinary catheterization in the previous 7 days was categorized as c ontinuous/indwelling or intermittent. Results: NUTI was the fifth most common nosocomial infection (129/1375: sim ilar to9%) and decreased in frequency during the decade from 0.9 to similar to0.6 cases/1000 patient days. Incidence was equal among men and women. On ly 50% of cases had prior instrumentation of the urinary tract. NUTI occurr ed disproportionately in newborns and infants (P <.001). The most common pa thogen was Escherichia coli (28%: 38/132), followed by Candida sp (18%; 24/ 134), Enterococcus (13%; 18/134), gram-negative nonfermenters (13%; 17/132) , Enterobacter (<similar to>10%; 13/134), Pseudomonas (9.7%; 13/134), and o ther (16%; 22/134). Three cases of secondary bacteremia occurred (2.3%; 95% confidence interval 0.5-6.6); there was no mortality. Conclusions: NUTI poses a less significant burden of illness (incidence, as sociated morbidity) than other nosocomial infection in children. If resourc es do not permit hospital-wide surveillance; high-risk children with urethr al instrumentation and newborns and infants could be targeted. Although E c oli remains the most common cause of pediatric NUTI, fungi have become the second most common pathogen in this tertiary care population. Risk factors for NUTI in noncatheterized children remain to be delineated.