[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.

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

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.

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.

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.


Tuesday, May 2, 2006 11:00 AM

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

Course Number: 5450A