Nosocomial infections in the pediatric intensive care unit: etiology and prevention

Ventilator-Associated Pneumonia in Children

The purpose of this report is to review the current knowledge base related to the epidemiology, microbiology, diagnosis, and morbidity and mortality of ventilator-associated pneumonia and to review strategies to reduce the risk of acquiring this condition. Published guidelines are based largely on data from adult populations, and implications for the pediatric population must be extrapolated to a great extent. Some interventions, including elevation of the head of the bed for most patients and deep vein thrombosis prophylaxis in older pediatric patients, seem reasonable based on available literature. The use of daily sedation holidays must be weighed against the risk of inadvertent extubation. The routine use of stress ulcer prophylaxis in the pediatric population cannot be supported by the current literature.

Pediatric intensive care unit nosocomial infections: epidemiology, sources and solutions

Nosocomial infections in the PICU remain a significant source of morbidity and mortality. The risk of infections in these patients remains high because invasive devices allow organisms to bypass normal host defenses. Additionally, this patient group often has coexisting metabolic or organ system dysfunctions. Antibiotic pressure has led to the development of drug-resistant organisms within the PICU, thereby causing infections that are increasingly difficult to control. The best current approach for preventing PICU infections centers on consistent hand washing between patients, early discontinuation of invasive devices, and appropriate isolation strategies. Insight into the causes and locations of PICU-related infections remains a crucial component in the success of preventive strategies.

Surveillance of infections in hospital: agents and antibiotic-resistance

The surveillance system for Hospital Acquired Infections (HAI) implemented in the S. Eugenio hospital of Rome allows to monitor the distribution of the micro-organisms by service and their resistance to antibiotics. It is based upon the data collected by the Central Analysis Laboratory of the hospital. The data of four high-risk departments (Surgical service, Intensive Care Unit, Haematology, Burn Unit) are reported. In the period October 1992-September 1993, 3909 samples have been analyzed; 1603 (43.1%) were found positive to the microbiologic analysis. The results of the antibiotic resistance concerning four micro-organisms, agents of HAI are reported and discussed. Surveillance systems are necessary to limit the frequency of HAI.