Nosocomial infections epidemiology and in-hospital mortality in a neonatal intensive care unit of a regional reference hospital. São Paulo, Brazil / Epidemiologia da infecção hospitalar e mortalidade intra-hospitalar de uma unidade de terapia intensiva neonatal em hospital de referência regional de São Paulo

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Nosocomial infections rates varies widely among Neonatal Centers suggesting that risk factors can be modify by assistance quality, newborn characteristics and infection control practices. The aim of this study was to analyze nosocomial infections epidemiology and mortality rate among neonates admitted to a Neonatal Intensive Care Unit of Hospital Geral de Itapecerica da Serra SECONCI SP OSS from January 1, 2002 to December 31, 2003. The study was carried out in a cohort model, with data analyze retrospectively but collected by active surveillance following the NNIS (National Nosocomial Infection Surveillance System) methodology. Neonates were classified according to Neonatal Therapeutic Intervention Scoring System (NTISS) to assess illness severity within the first 24 hours of admission. 486 newborn infants were included in the study: 426 (87.7%) inborn infants and 60 (12.3%) out born infants. Nosocomial infection incidence rate was 30.6% and the incidence density was 25.1 per 1000 patients-day (7.9 for early infections and 17.2 for late infections). Sepsis was the most frequent infection (54.0%), followed by pneumonia (20.0%). Among microbial agents isolated 54.3% were Gram-positive organisms, and coagulase-negative staphylococci were the most frequent. Most neonates have shown a severity score lower or equal to 19 (88.1%), and the maximum score was 39. Outborn neonates have shown a significant higher severity score. Nosocomial infections were associated with newborn severity index at admission. Nosocomial mortality rate was 8.6% and higher among out born neonates. Hospital infections were classified as cause or contributed for death in 26 (61.9%) neonates. No statistic association was seen between the neonate birth place and nosocomial infections. Univariate analyzes showed the following risk factors for late infections: prematurity, low birth weigh, low weight for gestational age, prenatal visits number, resuscitation following birth, respirator, central catheter and parenteral nutrition use, length of stay and severity score at admission. Multivariate logistic regression model included the following variables: birth weigh, therapeutic score within 24 hours of admission and parenteral nutrition use. Nosocomial infection epidemiology at HGIS´s UTIN is similar with what was observed in medical literature. It is dependent of newborn characteristics, assistance and infection control practices within the neonatal intensive care therapy, and is independent of newborn place of birth

ASSUNTO(S)

infection/epidemiology child mortality estudo de coorte cross infection cohort studies criança infecção hospitalar mortalidade na infância child infecção/epidemiologia

ACESSO AO ARTIGO

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