5450A4

[5450A.4] Bacteraemic Blood-Stream Infections (BSIs) in Neonatal Intensive Care Units (NICUs) in a Developing Country

Lim Nyok Ling, National Neonatal Registry. Department of Paediatrics, Selayang Hospital, Batu Caves, Selangor, Malaysia; Ministry of Health, Malaysia.

BACKGROUND: Infections are recognized as a significant factor causing morbidity and mortality in NICUs.

OBJECTIVE: This study aims to determine the rates and types of infections, identify possible risk factors and develop a performance indicator for standard of care in NICUs in Malaysia.

DESIGN/METHODS:
A National Neonatal Registry was set up to collect information on ill babies admitted to the NICUs. Inclusion criteria were babies who 1) had a gestation of <32 weeks 2) had a birthweight (BW) of 501-1500gms 3) were ventilated and 4) died within the neonatal period. For this specific study information pertaining only to bacteraemic blood-stream infections (BSIs) which was defined as clinical evidence of sepsis with positive blood culture, is analyzed. Statistical analysis was performed using Chi-square test for categorical variables and student t-test for continuous variable.

RESULTS: A total of 7351 cases from 24 NICUs was enrolled. Numbers from each centre varied from 714 in one to 71 in another. A total of 678 (9.2%) episodes of bacteraemic BSIs was reported with rates among centres varying from 0% to 14.7%. Infection rates in the two largest centres were 7.1% and 10.2% respectively.
The main infecting organisms were Coagulase-negative Staphylococcus (CONS) accounting for 171 (25.2%) infections followed by Methicillin-Resistant Staphylococcus aureus (MRSA) causing 134 (19.8%) infections.
Factors associated with a significantly higher risk of infections were BW of 501-1000g, OR 2.1 (CI:1.7-2.5); BW 1001-1500g, OR 1.6 (CI: 1.2-2.0); congenital heart disease,OR 2.6 (CI: 2.1-3.1); ventilatory support, OR 2.9 (CI: 2.0-4.1); postnatal steroid for bronchoplumonary dysplasia, OR 3.8(CI:2.9-5.1) and parenteral nutrition, OR 3.1 (CI:2.7-3.7) with a p value <0.0001 for all variables.
The mean duration of ventilation for babies with infection was 16 +/- 19 days and mean duration of hospital stay was 40 +/- 34 days. For babies without infections the durations were 10+/-16 and 32 +/- 29 days respectively. p< 0.001. Mortality was 26.8% for those who had infections and 23.1% for those without infections. p<0.03

CONCLUSIONS:
An infection rate of 9.2% is quite comparable to some developed countries. Centres with higher rates should make concerted efforts to improve on their performance in terms of clinical management and implementation of infection control policies.

E-PAS2006:59:5450A.4

Tuesday, May 2, 2006 11:00 AM

Platform Session: Neonatal Infectious Diseases in Developing Countries (10:15 AM - 12:15 PM)

Course Number: 5450A