Trends in paediatric nosocomial bacteraemia in a London tertiary hospital

Abstract

Aim: To describe the incidence and microbiological characteristics of nosocomial bloodstream infections in childhood over a 9-year period at a South London tertiary hospital.

Methods: Analysis of prospective data collected for clinically significant nosocomial bloodstream infections in children aged <16 years during 2001-2009.

Results: During the study period, although the absolute number of nosocomial bloodstream infections were similar for the neonatal unit (n = 254) and paediatric wards (n = 224), rates were 11.6-fold (95% CI, 9.8-13.9) higher for the former (5.8 vs. 0.50/100 discharges, respectively). Analysis of trends revealed a significant reduction in rates for both the neonatal unit (7.8-2.5 episodes/100 discharges; p < 0.001) and paediatric wards (1.2-0.4 episodes/100 discharges; p < 0.001), mainly due a decline in catheter-associated staphylococcal bacteraemia, which accounted for 115 (45%) and 164 (73%) episodes in the paediatric wards and neonatal units, respectively. Gram-positive cocci were the most frequent pathogens recovered, accounting for 200 (79%) and 185 (83%) cases in the neonatal unit and paediatric wards, respectively. Overall, antimicrobial resistance rates were low compared with other industrialized countries.

Conclusion: Nosocomial bloodstream infections rates declined significantly in our hospital over the past decade, likely driven by local introduction of national infection-control bundles particularly focussing on insertion and maintenance of intravascular catheters.

Keywords: Antibiotic resistance; Bacteraemia; Children; Nosocomial infection.