Epidemiology of infections in very low birth weight infants. Polish Neonatology Network research
Aim of study:
1. prospective record of infections; 2. prevention of nosocomial infections by providing current data about infections, which are significant for making therapeutic decisions.
Material and methods:
Recorded infections: early-onset sepsis (congenital), late-onset sepsis (acquired in hospital), necrotising enterocolitis (NEC), pneumonia. Infections were diagnosed and qualified on the basis of definitions of infections based on the National Nosocomial Infections Surveillance (NNIS) criteria, developed by CDC, USA, including modifications of German Neo-KISS programme. Infection control was realised as a part of common research project of "Polish Neonatology Network", appointed by the decision of the Minister of Science and Higher Education no. 669/E-215/BWSN- 0180/2008 dated 20.05.2008 r. The study was conducted by 6 Polish neonatology units, Microbiology Chair of Jagiellonian University Collegium Medicum and Institute of Theoretical and Applied Computer Science. Infants with birth weight lower than 1500 g were qualified for the study.
Between 1.01.2009 and 31.12.2009, 910 patients were registered, i.e. 19.1% of VLBW infants born in that period. The conducted analysis showed significant differences between centres in gestational age, birth weight, hospitalisation, use of invasive procedures, antibiotics and parenteral feeding. Cumulative morbidity rate was 68.5% total. Blood infection (sepsis) was the most commonly observed type of infection: 268 cases - 43.1% of all recorded forms of infection. Pneumonia was diagnosed in 242 cases, 38.8% total. NEC constituted 12.7% studied infections (79 cases). Apart from NEC, the risk of other forms of infection differed between centres. Dominant etiologic factor of all infections were Gram-positive cocci, which constituted 565 isolated microorganisms. Among them coagulase-negative staphylococci (CNS) were the most common (41.7%), while Staphylococcus aureus was fourth most frequent etiologic factor of infections (6.3% total).
1. Introduction of unified definition and criteria for diagnosing infections and the use of morbidity rates enables comparative analysis of epidemiology of infections in neonatal intensive care units. 2. Due to significant differences observed between prophylactic and therapeutic procedures in various units, it is essential to propose Polish recommendations regarding control over etiology of infections and use of invasive procedures, such as intravenous catheters and ventilation. 3. It is essential to undertake action leading to fully rational antibiotic therapy, because overuse of antibiotics leads to bacterial resistance and increases incidence of infections.
Available from: Mohammadhassan Aelami
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Ventilator-associated pneumonia (VAP) is relatively common in mechanically-ventilated children, but there is a wide
variation in reported VAP rates, depending on settings and geographical regions. Surveillance definitions in children
are challenging. Although these are provided by the German nosocomial infection surve
illance system and an
independent Dutch group, the combination of clinical an
d radiologic signs leaves room for interpretation. Of
note, the United States Centers for Disease Prevention and Control guidelines do not offer algorithms for neonates.
Despite the fact that most experts agree on the low sensitivity and specificity of existing definitions, little has changed
over the past years. However, the number of studies reporting on VAP prevention programs has increased in recent
years. Single interventions, such as chlorhexidine mouth wash or stress ulcer prophylaxis, were not effective. Successful
prevention programs combined multiple interventions, such as hand hygiene, glove and gown use for endotracheal
tube manipulation, backrest elevation, oral care with chlorhexidine, stress ulcer prophylaxis, cuff pressure maintenance
where appropriate, use of orogastric tubes, avoidance of gastric overdistension, and elimination of non-essential
tracheal suction. These multimodal strategies have proved to be successful among neonates, infants, and children.
Importantly, they are applicable in high- as well as in low- and middle-income countries. This review provides an
update of VAP incidence rates and summarizes current know
ledge on its epidemiology, risk factors, surveillance
definitions, and prevention prog
rams in the pediatric setting.
nia, Children, Neonates, Heal
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