Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study.

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.055.81) and length of stay (OR, 1.7; CI95, 1.31-2.21) (Infect Control Hosp Epidemiol 2000;21:340-342). Nosocomial infections (NIs) are among the most important causes of morbidity among hospitalized children.1 It is estimated that approximately one third of all NIs are preventable in hospitals with effective programs for controlling such infections.2 Critically ill pediatric patients admitted to pediatric intensive care units (PICUs) represent a high-risk group for NIs. The NI rate in PICUs varies from 3% to 27%.3,4 The mortality attributable to these infections is approximately 11%,4 and the cost per episode may reach $12,000 US per patient.5 Furthermore, in 40% of cases, it is necessary to remove catheters, postpone procedures, utilize isolation measures, readmit the patient to a PICU, or perform additional procedures.5 Knowing the risk factors for the development of NIs in the ICU is essential for implementation of adequate preventive measures.6 The objective of this study was to evaluate risk factors for NI in critically ill pediatric patients and to establish protocols to prevent and control NI within our hospital.