Risk factors associated with neonatal sepsis of nosocomial origin in patients at a Mexican Hospital

  • Georgina Romo-Hernández Hospital del Niño DIF
  • Marco A. Escamilla-Acosta Hospital del Niño DIF
  • Agustín Pérez-García Hospital del Niño DIF
  • Irma A. Espinosa-Oropeza Hospital del Niño DIF
Keywords: Newborn; Nosocomial Sepsis; Risk Factors.

Abstract

Nosocomial neonatal sepsis (NNS) is one of the principal causes of childhood morbidity and mortality and has a large impact on public health. Therefore, our objective was to determine the prevalence and risk factors associated with NNS in patients at Hospital del Niño DIF Hidalgo (Children’s Hospital, Hidalgo DIF). A retrospective case-control study was carried out by reviewing the medical records of 29 cases and 62 controls. The relative risk and odds ratio were calculated, and the Chi-squared test was used. The prevalence of NNS was found to be 13.6%. The statistically significant risk factors for NNS in premature infants were the male gender, the use of histamine H2 receptor blockers, a birth weight <1500 g, and an Apgar score <6. In full-term patients, the risk factors were respiratory insufficiency and anemia. The common risk factors in both groups were ventilatory assistance, presence of a central line, total parenteral nutrition, >7 days of antibiotic use, and presence of a bladder catheter. We found that the prevalence and risk factors in this study are similar to those reported in medical literature.

References

Orfari JL. Sepsis Neonatal. Nuevas estrategias terapéuticas. [Neonatal Sepsis. New therapeutic strategies.] Rev. Ped. Elec. 2004; 1:25–31.
Coto Cotallo GD, Fernández I. Protocolos de Neonatología Protocolo diagnóstico-terapéutico de la sepsis neonatal. [Neonatology protocols: Diagnostic-therapeutic protocol for neonatal sepsis.] Bol. Pediatr. 2006; 46:125–34.
López S, Fernández C. Sepsis en el recién nacido. [Sepsis in the newborn.] An. Pediatr. Contin. 2005; 3:18–27.
Reyna-Figueroa J. Disparidad en los criterios para incluir pacientes con sepsis neonatal en estudios médicos científico. [Disparity in the criteria for including patients with neonatal sepsis in scientific medical studies.] An. Pediatr. (Barc). 2006; 65:536–40
Goldstein B, Giroir B, Randolph A. Special article international pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics: Pediatr. Crit. Care Med. 2005; 6:2–8.
Ahued JR, Kunhardt J, Bolaños. Normas y procedimientos en neonatología. [Rules and procedures in neonatology.] Instituto Nacional de Neonatología 2003 [National Institute of Neonatology 2003]: 189–92. http://www.infectologiapediatrica.om/attachments/ Normas_INPer_Instituto_Nacional_de_Perinatologia.pdf. Accessed April 19, 2010
Saltigeral P, Valenzuela A, Avendaño E, Plascencia S, Martínez D. Agentes causales de sepsis neonatal temprana y tardía: una revisión de 10 años [Causal agents of early and late neonatal sepsis: a review of 10 years]; Rev. Enfer. Infec. Pediatr. 2007; 20:99–105.
Ramírez Sandoval MLP, Macías Parra M, Lazcano Ramírez F. Etiología de la sepsis neonatal en una unidad hospitalaria de segundo nivel. [Etiology of neonatal sepsis in a second-level hospital unit.] Salud Púb. Méx. 2007 49:391–3.
López Almaraz R, Hernández González MJ, Doménech Martínez E. Bacteriemias verticales: ¿tratar o no tratar?, [Vertical bacteremias: to treat or not to treat?] An. Esp. Pediatr. 2001; 54:160–4.
López-Sastre J, Fernández-Colomer B. Sepsis en el recién nacido. [Sepsis in the newborn.] An. Pediatr. Contin. 2005; 3:18–27.
Fortunov MR, Hulten KG. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006; 118:874–81.
Cetritto CC. Trabajo de Revisión, ¿Qué es sepsis en pediatría? [Review work. What is sepsis in pediatrics?] Arch. Venez. Pueri. Ped. 2003; 66:16–26.
López Sastre JB, Coto Cotallo GD, Ramos Aparicio M, De Alaiz Rojo, Polo Mellado C. Sepsis neonatal, Protocolos diagnósticos y terapéuticos en pediatría. [Neonatal sepsis, diagnostic and therapeutic protocols in pediatrics.] Neonatology 36:307–16.
Pérez Solís D. Procalcitonina en la sepsis neonatal nosocomial. [Procalcitonin in nosocomial neonatal sepsis.] An. Pediatr. (Barc) 2006; 64:349–53.
López Sastre JB, Pérez Solís D. Definiciones de sepsis neonatal: un largo camino por recorrer. [Definitions of neonatal sepsis: a long way to go.] An. Pediatr. (Barc). 2006; 65:525–8.
Pourcyrous M, Korones SB, Yang W, Boulden TF, Bada HS. C-Reactive protein in the diagnosis, management, and prognosis of neonatal necrotizing enterocolitis. Pediatrics 2005; 116:1064–9.
Manroe BL, Weimber AG, Rosenfeld CR Browne R. The neonatal blood count in health and disease. Reference values for neutrphilic cells. J. Pediatr. 1979; 95:89–98.
Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-Reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102:1–10.
Barroso AJ, Rivera-Rueda MA, Cosme-Pérez J, Santillan Palomo V, Rivas-Torres MP. Importancia del peso al nacer en la generación de infecciones nosocomiales en una Unidad de Cuidados. [Importance of birth weight in the generation of nosocomial infections in a Care Unit.] Bol. Med. Hosp. Infant. Mex. 2007; 64:288–94.
Morayta RA, Granados GEM, Pérez PGC, Domínguez VW. Incidencia de infecciones nosocomiales en la Coordinación de Pediatría del CMN “20 de noviembre”. [Incidence of nosocomial infections in the CMN Pediatric Coordination “20th of November”.] Rev. Enferm. Infecc. Ped. 2006; 19:71–8.
Martínez A, Anaya A, Avila F. Incidencia de bacteriemia y neumonía nosocomial en una unidad de pediatría. [Incidence of nosocomial bacteremia and pneumonia in a pediatric unit.] Salud Púb. Méx. 2001, 411:515–22.
Retamoza LA., Soto VH, Villarreal C. Incidencia de infecciones nosocomiales y germen causal más frecuente. [Incidence of nosocomial infections and most frequent causal germs.] Arch. Salud Sin. 2007; 1:106–9.
Heeg P. Infecciones nosocomiales en neonatología y unidades de cuidado intensivo neonatales. [Nosocomial infections in neonatology and neonatal intensive care units.] International Federation of Infection Control 2006;82–6.
Brodie SB, Sands K, Grays J, Parker R, Goldmann D, David R, Richardson D. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Ped. Infect. Dis. J. 2000; 19:56–65.
Reyna J, Briseño R, Ortiz-Ibarra FJ. Validación de la escala NOSEP-1 para el diagnóstico de sepsis nosocomial en recién nacidos prematuros menores de 1500 g. [Validation of the NOSEP-1 scale for the diagnosis of nosocomial sepsis in premature newborns weighing less than 1500 g. Bol. Med. Hosp. Infant. Mex. 2005; 62:321–8.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL. Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285–91.
Qian L, Liu C, Zhuang W, Guo Y, Yu J, Hanqiang C, et al. Neonatal respiratory failure: A 12-month clinical epidemiologic study from 2004 to 2005 in China. Pediatrics 2008; 121:1115–24.
Rodríguez-Weber MA, López-Candiani C, Arredondo-García JL, Gutiérrez-Castrellón P, Sánchez Arriega F. Morbilidad y mortalidad por sepsis neonatal en un hospital de tercer nivel de atención. [Morbidity and mortality of neonatal sepsis in a tertiary level hospital.] Salud Púb. Méx. 2003; 45:90–5.
Martinez SH, Casanueva E, Rivera DJ, Viteri FE, Borges RH. La deficiencia de hierro y la anemia en niños mexicanos. Acciones para prevenirlas y corregirlas. [Iron deficiency and anemia in Mexican children. Actions to prevent and correct it.] Bol. Med. Hosp. Infant. Mex. 2008; 65:86–99.
Hoyos A. Guías neonatales de práctica clínica basada en evidencia: enterocolitis necrotizante. [Neonatal clinical evidence-based practice guides: necrotizing enterocolitis.] Editorial Distribuna, Bogotá, Colombia. 2010:1-35.
Hoyos A. Guías neonatales de práctica clínica basada en evidencia: Infección en el recién nacido. [Neonatal clinical evidence-based practice guides: Infection in the newborn.] Editorial Distribuna, Bogotá, Colombia. 2006:36–47.
Apisarnthanarak A., Holzmann PG, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: Characteristics, risk factors, and outcomes. Pediatrics 2003; 112:1283–9.
Guillet R, Stoll BJ, Cotton CM, Gantz M. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight Infants. Pediatrics 2006; 117:137–42.
Grave GD, Nelson SA, Walker WA. New therapies and preventive approaches for necrotizing enterocolitis: Report of a research planning workshop. Pediatr. Res. 2007; 62:510–4.
Hoyos A. Guías neonatales de práctica clínica basada en evidencia: nutrición parenteral y catéter en el recién nacido. [Neonatal clinical evidence-based practice guides: parenteral nutrition and catheters in the newborn.] Editorial Distribuna, Bogotá, Colombia. 2006:48–62.
Sharon B, Kenneth S, James G, Robert P, Donald G, Roger B, Douglas R. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Ped. Infec. Dis. J. 2000; 19:56–65.
Taketomo CK. Manual de prescripción pediátrica. 14a edición, [Pediatric prescription manual, 14th edition.] Editorial Lexi Comp. México. 2010.
Benjamín DK, Millar W, Garges H, Benjamín DK. Bacteremia, central catheters, and neonates: When to pull the line. Pediatrics 2001; 107:1272–6.
Published
2012-12-05

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