On behalf of the Portuguese Registry of HCAI in the NICU.
Directorate-General of Health
- 3th UENPS Meeting 2012. 14-17/11. Porto (Comunicação oral).
- Selecionada para os "Academic Olympics".
Introduction: After years of filling in paper sheets, on line registry of hospital infections in Portuguese NICUs following Neo-Kiss definitions started in 2008. Unlike Neo-Kiss all newborn infants admitted to the NICU are registered. All hospitals have access to their own results and national data for comparison and benchmarking.
Aim: To deliver data on a 4 years registry on hospital-acquired infections in Portuguese NICUs
Methods: Descriptive analysis of data. On line registry accessed as June the 20th. Population: all cases registered with admission date between January the 1rst 2008 and December 31, 2011. Episodes of infection include clinical sepsis, bloodstream infection pneumonia, meningitis and necrotizing enterocolitis. Evolution of success measures was studied along the four years.
Results: In the study period 20056 newborn infants were registered accounting for 294965 admission days; 54.4% needed intensive care (121890 intensive care days); 3476 patients had birth weight under 1500g (VLBW) (17.3%) and 1319<1000g (ELBW)(6.5%); 16,9% were ventilated (ventilation days-28449), 38.9% had a central line for 85049 central line-days; 3,9% were operated on; 9% had hospital-acquired infection for a total of 2243 episodes (1.2 episodes/patient) (7.6 episodes/1000 treatment days). Infection rate was higher in ELBW, VLBW and surgical patients–respectively 49%, 33.7% and 32.1%. Density of incidence of sepsis was 7.6/1000 treatment days–15.1/1000 for ELBW, 11.3/1000 for VLBW; rate of associated central line sepsis was 16/1000CVC days–22.5/1000 for ELBW, 12.7/1000 for VLBW; tracheal tube associated pneumonia was 5.6/1000 ventilation days–7.6/1000 for ELBW, 6.6 for VLBW. There were 1147 isolates; the most common were coagulase negative Staphylococcus (CONS) (68.4%); the second most frequent was S. aureus (12.6%). Data include 9 group B Streptococcus and 46 E. coli. Four hundred sixty two CONS were tested for methicillin, 434 were resistant (93.9%); there were no resistance to vancomycin; 102 S. aureus were tested for methicillin and 22.6% were resistant; 37% of Klebsiella spp tested for cefotaxime were resistant as well as 50% for ceftazidime and 40% for gentamicin. Resistance to meropenem was not found. All other bacteria had less than 40 isolates. Case fatality rate was 4.5%. Along the four years a slight increase in the incidence of infection in the different groups was found.
Conclusion: National registry allowed knowing basal rates of infection. High rates of infection were found mainly in the ELBW infants. It was supposed that registry and surveillance should improve results but it is not yet being used as profit by all enrolled NICUs.
Key-words: Prospective surveillance, nosocomial infection, neonatal intensive care units.