Healthcare-associated infections in a neonatal intensive care unit

Incidence of Central Line-Associated Bloodstream Infection in a Tertiary Care Hospital in Northern India: A Prospective Study

Background Central line-associated bloodstream infection is the most common hospital-acquired infection and is associated with high morbidity and mortality along with increased healthcare cost. However, studies on the incidence of nosocomial infections are very limited in India. Aims To determine the incidence of central line-associate bloodstream infection (CLABSI), microorganisms associated and their antimicrobial sensitivity profile in the medical ICU of a tertiary care hospital. Material and methods A total of 186 patients who were admitted to the medical ICU and had a non-tunneled central venous catheter (CVC) implanted at admission in the emergency department or in the medical ICU for longer than 48 hours were monitored. By examining the blood culture reports, the patients were monitored every day for the emergence of new-onset sepsis after 48 hours following CVC insertion. The data were evaluated statistically using Microsoft Excel and SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Result Out of 186 catheterized patients, 37 developed CLABSI. The incidence of CLABSI was 9.3 per 1000 catheter days and 6.7 per 1000 inpatient days with a 0.7 device utilization ratio. The most common organism isolated was Acinetobacter species (22%) followed by K. pneumoniae (16%) and E. aerogenes (16%). The highest sensitivity was displayed by polymyxin B (100%) followed by tigecycline (85.48%) and minocycline (50.82%) in Gram-negative organisms. In Gram-positive organisms, the highest sensitivity was observed in S. aureus (100%) for vancomycin, linezolid and teicoplanin whereas Enterococcus species showed linezolid (100%) followed by vancomycin (93.75%) and teicoplanin (93.75%). Conclusion The prevention of CLABSI requires knowledge of the infection rates and of the sources, the pathogens involved as well as their antimicrobial profile. Due to rising antimicrobial resistance, surveillance programs are crucial in establishing the species distribution and resistance patterns of bacteria causing BSIs and thus providing the basis for appropriate empirical therapy.

Effects of implementation of healthcare associated infection surveillance and interventional measures in the neonatal intensive care unit: Small steps matter

PURPOSE

Neonatal sepsis has been a global concern considering the mortality and morbidity. This study was undertaken to determine the effects of implementation of interventions namely healthcare associated infection (HAI) surveillance and hand hygiene (HH) monitoring in the neonatal intensive care unit (NICU).

MATERIALS AND METHODS

The cohort study was conducted in the NICU of a tertiary care hospital over a period of June-September 2021 (pre-intervention) to October-March 2022 (post-intervention). HAI surveillance of primary bloodstream infections (BSI) and HH monitoring was initiated as interventions post outbreak due to non-albicans Candida (NAC). The primary outcome of the interventions was to record any improvement in HH rates or any change in HAI rates in the 6 months intervention period. Characteristics of the pre- and post-intervention period were compared by Fisher exact test.

RESULTS

There was significant reduction in BSI cases in the post-intervention period (p ​< ​0.05). Mortality and BSI due to NAC were significantly more in the pre-intervention period even though low birth weight neonates (<2500 ​g) were significantly more in the post-intervention period (p ​< ​0.05). The HAI rate for primary BSI in the NICU was 10.82 per 1000 patient days. The overall adherence rate to HH was 10.68% (complete) and 73.35% (partial). HAI rates were seen to change reciprocally with changes in HH rates.

CONCLUSIONS

HAI rates of primary BSI in the NICU could be regulated by the effective implementation of HAI surveillance, HH monitoring, feedback meetings with the NICU staff and other simple interventional measures even in resource-limited setups.

Serratia marcescens Colonization in a Neonatal Intensive Care Unit Has Multiple Sources, with Sink Drains as a Major Reservoir

Compelling evidence suggests a contribution of the sink environment to the transmission of opportunistic pathogens from the hospital environment to patients in neonatal intensive care units (NICU). In this study, the distribution of the opportunistic pathogen Serratia marcescens in the sink environment and newborns in a NICU was investigated. More than 500 sink drain and faucet samples were collected over the course of five sampling campaigns undertaken over 3 years. Distribution and diversity of S. marcescens were examined with a modified MacConkey medium and a high-throughput short-sequence typing (HiSST) method. Sink drains were an important reservoir of S. marcescens, with an average of 44% positive samples, whereas no faucet sample was positive. The genotypic diversity of S. marcescens was moderate, with an average of two genotypes per drain, while the spatial distribution of S. marcescens was heterogeneous. The genotypic profiles of 52 clinical isolates were highly heterogeneous, with 27 unique genotypes, of which 71% of isolates were found in more than one patient. S. marcescens acquisition during the first outbreaks was mainly caused by horizontal transmissions. HiSST analyses revealed 10 potential cases of patient-to-patient transmission of S. marcescens, five cases of patient-to-sink transmission, and one bidirectional transfer between sink and patient. Environmental and clinical isolates were found in sink drains up to 1 year after the first detection, supporting persisting drain colonization. This extensive survey suggests multiple reservoirs of S. marcescens within the NICU, including patients and sink drains, but other external sources should also be considered. IMPORTANCE The bacterium Serratia marcescens is an important opportunistic human pathogen that thrives in many environments, can become multidrug resistant, and is often involved in nosocomial outbreaks in neonatal intensive care units (NICU). We evaluated the role of sinks during five suspected S. marcescens outbreaks in a NICU. An innovative approach combining molecular and culture methods was used to maximize the detection and typing of S. marcescens in the sink environment. Our results indicate multiple reservoirs of S. marcescens within the NICU, including patients, sink drains, and external sources. These results highlight the importance of sinks as a major reservoir of S. marcescens and potential sources of future outbreaks.

Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020

BackgroundHospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcusspp. (VRE), are of rising concern.AimWe summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region.MethodsWe searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates.ResultsWe included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7-13.4; range: 6.1-17.5) and 1.1% (95% CI: 0.21-2.7; range: 0.39-2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76-19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3-13.5; range: 0.39-36.0) and 2.6 (95% CI: 0.53-5.8; range: 0-9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5-16.3; range: 2.6-11.5). In ICU, this proportion was 11.5% (95% CI: 4.7-20.1; range: 0-40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7-28.9; range: 14.3-32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0-57.3; range: 14.3-41.3).ConclusionsInfections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.

Profiles of microorganisms isolated from neonates' blood cultures, incubators, cradles, ventilators, washbasins, and health-workers of Libreville University Hospital Neonatal Service: focus on infection prevention and control measures

Background

Nosocomial infection outbreaks in neonatal services are a serious healthcare concern in both developed and developing countries, but few studies have been conducted in sub-Saharan Africa.

Objective

This study explored the etiology of septicemia in neonates and associated patterns of antimicrobial susceptibility in Gabon.

Methods

We analyzed cultures from neonates’ blood and swabs from medical personnel and equipment located in the neonatology service.

Results

Sixty-eight microorganisms were isolated from the medical personnel and equipment; 46 microorganisms were isolated from neonates’ blood culture. Klebsiella pneumoniae spp pneumoniae was the most common bacteria found in both (30.6% and 26.9%, respectively). All Klebsiella pneumoniae spp pneumonia isolates were resistant to amoxicillin with clavulanic acid, gentamycin resistance ranged from 93% to 100%, and cephalosporin resistance ranged from 33.3% to 47%.

Conclusions:

Awareness of the etiology, prevalence, and outcome of nosocomial infection is the first and most important step to appropriate interventions.

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study

BACKGROUND

Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis.

METHODS

A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey.

RESULTS

The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005).

CONCLUSIONS

Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.

[Neonatal healthcare associated-infections in the Maghreb. A systematic review and meta-analysis]

BACKGROUND

Healthcare-associated infections are a major source of morbidity and mortality in neonatology. Our aim was to describe the epidemiology of Healthcare-associated infections in neonatology (frequency, associated factors and prognosis).

METHODS

Articles were searched in the PubMed, Scopus and Web of Science databases. We included observational studies describing prevalence, incidence or mortality among new-born babies having developed infections more than 48hours after hospitalization. The pooled prevalence, incidence and mortality estimates were analysed using the random effects model. Publication bias was analysed using the funnel plot and Egger's test statistics. Data analysis was carried out using R Studio software v1.2.

RESULTS

Among the initially identified 137 studies, ten articles fulfilled the inclusion criteria and were included in the metanalysis. They mainly concerned Morocco, Tunisia and Algeria. Pooled incidence was 10% (95% CI [4%-18%]) and overall mortality was 49% (95% CI [33%-66%]). Heterogeneity between studies was significantly high, with rates of 98% and 90% respectively.

CONCLUSION

This review underlined a need to undertake more large-scale multicentric surveys and studies on monitoring systems and the attitudes and practices of relevant caregivers, the objective being to better understand the realities of healthcare-associated infections in Greater Maghreb neonatology units.

The Effect of Single-Room Care Versus Open-Bay Care on the Incidence of Bacterial Nosocomial Infections in Pre-Term Neonates: A Retrospective Cohort Study

INTRODUCTION

Nosocomial infections (NIs) are a major source of iatrogenic harm in neonatal intensive care units (NICUs). The influence of the infrastructure of NICUs on NIs is not well documented. This study aims to examine the effect of single-room units (SRU) versus open-bay units (OBU) on the incidence of NIs, including central-line-associated bloodstream infections (CLABSI), in preterm neonates.

METHODS

All preterm neonates (< 32 weeks gestational age) admitted to our NICU were included. Two study periods were compared: one prior to (May 2015-May 2017) and one following (May 2017-May 2019) transition from OBU to SRU. Incidence density (number of infections per 1000 patient-days) and cumulative incidence (number of infections per 100 neonates) for NIs were calculated. CLABSIs were calculated per 1000 central-line days. U chart analysis was performed to determine special-cause variation in quarterly CLABSI and NI rates. Multivariate competing risk regression was performed to identify independent NI risk factors.

RESULTS

Of the 712 included infants, 164 (23%) infants acquired ≥ 1 NIs. No differences were found in incidence density (13.68 vs. 12.62, p = 0.62) or cumulative incidence of NI (23.97 vs. 22.02, p = 0.59) between OBU and SRU. CLABSIs showed a similar non-significant reduction after the move (14.00 vs. 10.59, p = 0.51). U chart analysis did not identify unit transition as a potential source of special-cause variation for CLABSI and NI. Competing risks regression analysis revealed longer duration of invasive mechanical ventilation as a significant risk factor for NI (subhazards ratio: 1.03 per day on ventilation, p = 0.01).

CONCLUSION

Single-rooms are not associated with a significant reduction in NIs in the NICU. This study therefore does not add evidence that could support the transition to SRUs if based only on a large multimodal infection control strategy. Recommendations to build SRUs would require a wider justification, also taking into account other SRU benefits.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40121-020-00380-9.

The significance of polymorphisms in genes encoding Il-1β, Il-6, TNFα, and Il-1RN in the pathogenesis of intraventricular hemorrhage in preterm infants

INTRODUCTION

Intraventricular hemorrhage (IVH) is a significant morbidity seen in very low birth weight infants. Genes related to inflammation may be risk factors for IVH.

MATERIAL AND METHODS

We examined five polymorphisms for an association with IVH in 100 preterm infants born from singleton pregnancy, before 32 + 0 weeks of gestation, exposed to antenatal steroid therapy, and without congenital abnormalities. These polymorphisms include interleukin-1β 3953 C>T, interleukin-6 -174G>C and -596G>A, tumor necrosis factor -308 G>A, and 86 bp variable number tandem repeat polymorphism of interleukin-1 receptor antagonist (Il -1RN 86 bp VNTR).

RESULTS

In our study population, 45 (45%) infants developed IVH, including 15 (33.33%) with stage 1, 19 (42.22%) with stage 2, 8 (17.77%) with stage 3, and 3 (6.66%) with stage 4. In contrast to the previously published data, the prevalence of IVH did not vary between infants with different IL-6 and TNFα alleles and genotypes. Our novel investigations in Il-1 +3953 C>T and Il-1RN 86 bp VNTR polymorphism did not show any significant link between those alleles or genotypes and IVH.

CONCLUSIONS

IVH is a significant problem for preterm infants. In addition to little progress in preventing IVH in preterm babies, substantial research that are focused on understanding the etiology, mechanism and risk factors for IVH are imperative. In the era of personalized medicine, identification of genetic risk factors creates opportunities to generate preventative strategies. Further studies should be performed to confirm the role of genetic factors in etiology and pathogenesis of IVH.

Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section

INTRODUCTION

This study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity.

MATERIAL AND METHODS

Nine hundred and sixty-five neonates ≥ 37 weeks' gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed.

RESULTS

Transient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admitted to the neonatal unit and neonatal intensive care unit (NICU) was significantly higher in group II than in group I (6.41% and 2.14% vs. 2.05% and 0.58%, respectively; p = 0.001 and p = 0.033, respectively). Surfactant, fluid therapies and parenteral nutrition were significantly more frequent in group II than in group I (2.14%, 4.28% and 2.49% vs. 0.15%, 1.46% and 0.73%, respectively; p = 0.001, p = 0.009 and p = 0.02, respectively).

CONCLUSIONS

Neonatal respiratory morbidity associated with ECS significantly decreased after antenatal oxytocin exposure. A significant reduction of neonatal respiratory morbidity would be achieved if ECS were performed after 39 weeks' gestation.

Magnetic resonance imaging of neonates in the magnetic resonance compatible incubator

INTRODUCTION

The authors present the first experience in neonatal magnetic resonance imaging (MRI) examinations using an MR compatible incubator (INC) at the Institute of Mother and Child.

MATERIAL AND METHODS

Forty-nine examinations of 47 newborns (20 girls, 27 boys) were performed using the GE Signa HDxt 1.5T system and INC Nomag IC 1.5. Demographic data, anesthetic methods and MRI findings in the INC in comparison with previously performed imaging were analyzed.

RESULTS

Thirty-two neonates were prematurely born (68.1%) at gestational age 23-37 weeks, mean: 29.9 weeks. They were examined at 26 weeks postmenstrual age to 1 month corrected age, mean: 37.5 weeks. Body weight of newborns on the study day was 600-4300 g, mean: 2724 g. Seventeen (34.7%) children were examined in physiological sleep, 32 (65.3%) anesthetized. In none of them did anesthesiological complications or disease worsening occur. In 43 (91.5%) children brain MRI was performed, in 4 (8.5%) MRI of the spinal cord and canal and of the abdomen/pelvis. In children prenatally examined by MRI, the INC provided new diagnostic information in 5 (83.3%) cases, in neonates studied after birth by ultrasound in 32 (82%). Magnetic resonance imaging in the INC did not entail additional knowledge in 9 (18.7%) cases.

CONCLUSIONS

The INC enables MRI in preterm newborns and those with low/extremely low body weight. These studies are necessary to assess the extent of changes in the central nervous system and other organs. Incubator coils, designed specifically for neonates, allow more accurate diagnosis than previously used coils for adults. MRI results allow one to determine prognosis, for more accurate planning of diagnostics, helping to make appropriate therapeutic decisions.

Colonization of multidrug resistant pathogens in a hybrid pediatric cardiac surgery center

INTRODUCTION

The incidence of multidrug resistant microorganisms worldwide is increasing. The aim of the study was to present institutional experience with the multidrug resistant microorganism colonization patterns observed in children with congenital heart diseases hospitalized in a hybrid pediatric cardiac surgery center.

MATERIAL AND METHODS

Microbiological samples were routinely collected in all children admitted to our department. All microbiological samples were analyzed with regard to multidrug resistant microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Gram-negative rods producing extended-spectrum beta-lactamases (ESBL), multidrug resistant Gram-negative rods (MDR-GNRs), carbapenemase-producing Klebsiella pneumoniae (KPC), carbapenem-resistant Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA).

RESULTS

In 30 (9%) swabs 'alert' pathogens from the above group of listed microorganisms were found. All positive swabs were isolated in 19 (16.1%) children. Multidrug resistant pathogen colonization was statistically significantly more often observed in children admitted from other medical facilities than in children admitted from home (38% vs. 10%, p = 0.0089). In the group of children younger than 6 months 'alert' pathogen were more often observed than in older children (34.1% vs. 5.4%, p < 0.001).

CONCLUSIONS

Preoperative multidrug resistant pathogen screening in children admitted and referred for congenital heart disease procedures may be of great importance since many of these patients are colonized with resistant bacteria. Knowledge of the patient's microbiome is important in local epidemiological control along with tailoring the most effective preoperative prophylactic antibiotic for each patient. The impact of preoperative screening on postoperative infections and other complications requires further analysis.

Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates: a pilot study

INTRODUCTION

To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS).

MATERIAL AND METHODS

This is a retrospective study conducted at a Malaysian government hospital. Records of neonatal patients admitted within 72 h of life and prescribed with empirical antibiotic therapy for suspected EOS were reviewed.

RESULTS

Three hundred and twenty-three cases met the inclusion criteria and were divided into gestational age (premature < 36 weeks; term ≥ 37 weeks) and birth weight (low birth weight (LBW) < 2.5 kg; normal body weight (NBW) ≥ 2.5 kg) groups. Premature (n = 197) and LBW (n = 194) neonates required significantly longer hospital stay, a higher degree of ventilator support and more surfactant (p = 0.001). More than 90.0% of premature and LBW neonates were diagnosed with respiratory distress syndrome, congenital pneumonia and presumed sepsis. Term (n = 123) and NBW (n = 129) neonates had greater maternal risk factors, especially meconium-stained amniotic fluid (MSAF) and perinatal asphyxia. The incidence of demonstrated EOS was 3.1%. Crystalline penicillin plus gentamicin was the standard therapy for all groups and was started within 24 h of life, with a mean treatment duration of ∼4 days. The treatment success rate was 89.0%, and only LBW neonates showed a higher risk of overall treatment failure (OR = 3.75; 95% CI: 1.22-11.53). Seventy-four percent of term and NBW neonates discharged well, while 42.0% of premature and LBW neonates required referral.

CONCLUSIONS

Crystalline penicillin plus gentamicin prescribed within 24 h of life is effective in the prevention of EOS. However, low birth weight neonates have a higher risk of treatment failure.

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

Background

Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce.

Objective

To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.

Methods

This case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences.

Results

During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041).

Conclusions

Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.

Nosocomial rotavirus gastroenterocolitis in a large tertiary paediatric hospital in Warsaw, 2006-2010

INTRODUCTION

Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There are limited data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries, including Poland. The aim of our study was to analyse the epidemiology of NRVG in a large tertiary hospital in Warsaw.

MATERIAL AND METHODS

We analysed retrospectively data of 63 173 patients aged 0-18 years hospitalized in the period 2006-2010. Nosocomial rotavirus gastroenterocolitis was defined as acute gastroenterocolitis (> 3 loose, or looser than normal, stools in 24 h and/or vomiting), confirmed with rapid immunochromatographic test (BioMaxima, Poland), if symptoms developed > 48 h after admission.

RESULTS

In total 575 cases of NRVG were diagnosed. The cumulative attack rate of NRVG was calculated as 0.91% (95% CI: 0.85-0.98%). The incidence density was 2.05/1000 bed-days (95% CI: 0.19-0.22/1000 bed-days). The mean proportion of NRVG among all rotavirus infections was 24%. The highest rates of NRVG were noted at wards where the mean duration of hospital stay was longer than 5 days (General Paediatrics and Neonatal Pathology). Seventy-one percent of children with NRVG were younger than 2 years. The mean duration of hospital stay of children with NRVG was longer than the average duration of hospitalization (11.6 days vs. 4.6 days, p < 0.01).

CONCLUSIONS

Our study showed a relevant incidence of NRVG, which can prolong the children's hospital stay. Limiting the number of NRVG is important to improve patients' safety and to avoid additional costs. Routine vaccination against rotavirus diseases could reduce the number of NRVG.