Summary:
Background: Nosocomial bloodstream infection in
paediatric ICU is a leading, preventable infectious
complication in critically ill patients and has a negative
impact on patient’s outcome. This study was done to
determine the type of pathogens responsible for nosocomial
infections and its sensitivity pattern, to evaluate the probable
sources (fomites) of nosocomial infections and also to
compare the outcome of treatment between children with
and without nosocomial bloodstream infections in terms of
length of ICU stay and mortality
Material and methods: This study was conducted in the
intensive care unit of Dhaka Shishu(children) hospital.
Children between 0-5 years of age were included in the study.
Blood culture positive case at the time of admission and
Children discharged or died within 48 hours of admission
were excluded. When children clinically suspected to have
nosocomial infections, their blood culture and swab culture
of probable sources were done.
Results: Out 110 patients, 23(20.9%) patients developed
nosocomial BSI. Neonates were found to be more
susceptible to develop nosocomial BSI. Most of the
organisms (86%) were Gram negative bacilli. Klebsiella was
the most common pathogens (30.78%) followed by
acinatobacter (21.73%), E-coli (13.04%), Pseudomonas
(8.7%). Type of micro-organisms and their sensitivity pattern
obtained from blood culture and sources culture of
corresponding patient were almost similar which indicate
the clue for probable source of nosocomial infection.
Microorganisms were almost sensitive to Imipenem but
there were high resistance to commonly used antibiotics
including third generation cephalosporins. ICU acquired
infections increase hospital mortality and duration of
hospital stay.
Conclusion: Nosocomial bloodstream infections in children
in ICU are associated with high mortality rate and prolong
hospital stay. Neonates are more susceptible to develop
nosocomial BSI than children aged above 28 days. Gram
negative organisms are predominant isolates and are
developing resistance to commonly used antibiotics
including third generation cephalosporin. Imipenem is the
most effective and reliable antibiotic option. Fomites
especially health care device including IV canula, suction
catheter, endotracheal tubes, oxygen mask are the important
probable sources of nosocomial infections.
(J Bangladesh Coll Phys Surg 2017; 35: 115-122)