Nosocomial infections in a neonatal intensive care unit: a 3-year cohort study

Edison Nagata, Angela SJ Brito, Tiemi Matsuo


Advances in medical care technology have contributed to longer survival and prolonged hospitalization of immunologically compromised neonates that are exposed to frequent invasive procedures. The objectives of this study were to determine the incidence, the most common infections and the risk factors for nosocomial infections (Nis) in a neonatal intensive care unit (NICU) in the south of Brazil.

A cohort study was conducted with 503 neonates, from February 2004 to October 2007, identifying those with NIs. All neonates were followed-up and the exposure to risk factors was assessed. The results were submitted to c2 test and to multivariate analysis.

The infection rate and the incidence density were 55.9% and 64.7 infections per 1000 patient-days, respectively. The sites of infection, in order of frequency were: pneumonia, primary bloodstream infection, meningitis, skin infection and necrotizing enterocolitis. The multivariate analysis identified 4 independent risk factors for nosocomial infection: mechanical ventilation, total parenteral nutrition (TPN), peripherally inserted central catheter (PICC) and birth weight. The most prominent isolated pathogens were coagulase-negative Staphylococcus (45.4%), Candida spp (25.8%) and Gram-negative rods (20.6%).

The most common infections were consistent with the literature; however, the incidence was much higher than in other studies. Although the risk factors have already been reported by many authors, they had not been identified in our unit before and, therefore, they were valuable in raising the awareness of our health care professionals.

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