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Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related

BACKGROUND: Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for N...

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Autores principales: Aziz, Khalid, McMillan, Douglas D, Andrews, Wayne, Pendray, Margaret, Qiu, Zhenguo, Karuri, Stella, Lee, Shoo K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182378/
https://www.ncbi.nlm.nih.gov/pubmed/16004613
http://dx.doi.org/10.1186/1471-2431-5-22
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author Aziz, Khalid
McMillan, Douglas D
Andrews, Wayne
Pendray, Margaret
Qiu, Zhenguo
Karuri, Stella
Lee, Shoo K
author_facet Aziz, Khalid
McMillan, Douglas D
Andrews, Wayne
Pendray, Margaret
Qiu, Zhenguo
Karuri, Stella
Lee, Shoo K
author_sort Aziz, Khalid
collection PubMed
description BACKGROUND: Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for NI, as well as the risk-adjusted variations in NI rates among Canadian NICUs. METHODS: From January 1996 to October 1997, data on demographics, intervention, illness severity and NI rates were submitted from 17 Canadian NICUs. Infants admitted at <4 days of age were included. NI was defined as a positive blood or cerebrospinal fluid culture after > 48 hrs in hospital. RESULTS: 765 (23.5%) of 3253 infants <1500 g and 328 (2.5%) of 13228 infants ≥1500 g developed at least one episode of NI. Over 95% of episodes were due to nosocomial bacteremia. Major morbidity was more common amongst those with NI versus those without. Mortality was more strongly associated with NI versus those without for infants ≥1500 g, but not for infants <1500 g. Multiple logistic regression analysis showed that for infants <1500 g, risk factors for NI included gestation <29 weeks, outborn status, increased acuity on day 1, mechanical ventilation and parenteral nutrition. When NICUs were compared for babies <1500 g, the odds ratios for NI ranged from 0.2 (95% confidence interval [CI] 0.1 to 0.4) to 8.6 (95% CI 4.1 to 18.2) when compared to a reference site. This trend persisted after adjustment for risk factors, and was also found in larger babies. CONCLUSION: Rates of nosocomial infection in Canadian NICUs vary considerably, even after adjustment for known risk factors. The implication is that this variation is due to differences in clinical practices and therefore may be amenable to interventions that alter practice.
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spelling pubmed-11823782005-08-04 Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related Aziz, Khalid McMillan, Douglas D Andrews, Wayne Pendray, Margaret Qiu, Zhenguo Karuri, Stella Lee, Shoo K BMC Pediatr Research Article BACKGROUND: Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for NI, as well as the risk-adjusted variations in NI rates among Canadian NICUs. METHODS: From January 1996 to October 1997, data on demographics, intervention, illness severity and NI rates were submitted from 17 Canadian NICUs. Infants admitted at <4 days of age were included. NI was defined as a positive blood or cerebrospinal fluid culture after > 48 hrs in hospital. RESULTS: 765 (23.5%) of 3253 infants <1500 g and 328 (2.5%) of 13228 infants ≥1500 g developed at least one episode of NI. Over 95% of episodes were due to nosocomial bacteremia. Major morbidity was more common amongst those with NI versus those without. Mortality was more strongly associated with NI versus those without for infants ≥1500 g, but not for infants <1500 g. Multiple logistic regression analysis showed that for infants <1500 g, risk factors for NI included gestation <29 weeks, outborn status, increased acuity on day 1, mechanical ventilation and parenteral nutrition. When NICUs were compared for babies <1500 g, the odds ratios for NI ranged from 0.2 (95% confidence interval [CI] 0.1 to 0.4) to 8.6 (95% CI 4.1 to 18.2) when compared to a reference site. This trend persisted after adjustment for risk factors, and was also found in larger babies. CONCLUSION: Rates of nosocomial infection in Canadian NICUs vary considerably, even after adjustment for known risk factors. The implication is that this variation is due to differences in clinical practices and therefore may be amenable to interventions that alter practice. BioMed Central 2005-07-08 /pmc/articles/PMC1182378/ /pubmed/16004613 http://dx.doi.org/10.1186/1471-2431-5-22 Text en Copyright © 2005 Aziz et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Aziz, Khalid
McMillan, Douglas D
Andrews, Wayne
Pendray, Margaret
Qiu, Zhenguo
Karuri, Stella
Lee, Shoo K
Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title_full Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title_fullStr Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title_full_unstemmed Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title_short Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related
title_sort variations in rates of nosocomial infection among canadian neonatal intensive care units may be practice-related
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182378/
https://www.ncbi.nlm.nih.gov/pubmed/16004613
http://dx.doi.org/10.1186/1471-2431-5-22
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