Healthcare-associated infections in a neonatal intensive care unit in Turkey

Abstract

To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit. Prospective, cohort. A 38-bed, teaching, referral, neonatal intensive-care unit. All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P < 0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.