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422 Nosocomial Bloodstream Infection in an Algerian Neonatal Intensive Care Unit: A 2-year Prospective Study

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Mohamed Lamine Atif, MD, MSc , University Hospital of Blida, Blida, Algeria
Fetta Sadaoui, MD , University Hospital of Blida, Blida, Algeria
Abdeldjallil Bezzaoucha, MD, PhD , University Hospital of Blida, Blida, Algeria
Chawki Ahmed Kaddache, MD, PhD , University Hospital of Blida, Blida, Algeria
Rachida Boukari, MD, PhD , University Hospital of Blida, Blida, Algeria
Salima Djelato, MD , University Hospital of Blida, Blida, Algeria
Background: Bloodstream infection (BSI) is the most common nosocomial infection in neonatal intensive care units (NICUs). It contributes to poor outcomes and increases the cost of critically ill patients. Little is known about the epidemiology of Nosocomial BSI in Algerian NICUs.

Objective: To determine incidence, microbiology, risk factors, and mortality of nosocomial BSI in Algerian NICU patients.

Methods: A prospective surveillance study from April 2004 through April 2006 was performed in the NICU of the Blida University Hospital. All patients who remained in the NICU for more than 48 hours were included. Diagnostic of NBI was performed using Centers for Disease Control and prevention definitions. The risk factors of BSI were identified using a logistic-regression model.

Results: A total of 2864 neonates were surveyed. The overall nosocomial BSI incidence rate was 2.7%. The BSI rates by birth-weight-category were: ≤ 1000 g, 20.8%; 1001-1500 g, 9.9%; 1501-2500 g, 3.1%; > 2500 g, 1.5% (p<0.001). The most common pathogens included Klebsiella pneumoniae (55.6%) and Staphylococcus aureus (27.8%). The mortality in infants with nosocomial BSI was 53.2% vs. 4.1% in non infected babies (relative risk = 12.9, 95% confidence interval (CI) 9.8-17.0; p < 0.001). In the multivariate regression model, variables significantly associated with nosocomial BSI included birth-weight (odds ratio (OR) = 5.30, 95%CI 2.82-9.95; p < 0.001), antibiotic use before onset of infection (OR = 7.20, 95%CI 1.71-30.23; p < 0.01), and parenteral nutrition (OR = 5.11, 95%CI 2.99-8.73; p < 0.001).

Conclusions: This is the first study reporting the incidence of nosocomial BSI in Algerian NICU patients. The nosocomial BSI rates are consistent with the studies reported from many developed countries in NICU patients. However, the mortality attributable to these infections was much higher in our NICU. Implementation of improved infection control practices is required.