@article {1617, title = {Determinants of nosocomial infection in 6 neonatal intensive care units: an Italian multicenter prospective cohort study.}, journal = {Infect Control Hosp Epidemiol}, volume = {31}, year = {2010}, month = {2010 Sep}, pages = {926-33}, abstract = {

BACKGROUND: Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs).

OBJECTIVE: To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection.

DESIGN: A multicenter, prospective cohort study.

PATIENTS AND SETTING: A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay.

METHODS: Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated.

RESULTS: A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95\% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95\% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95\% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95\% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95\% CI, 1.5-3.5]).

CONCLUSIONS: Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.

}, keywords = {Bacteremia, Birth Weight, Cross Infection, Gestational Age, Hospitals, University, Humans, Incidence, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Italy, Length of Stay, Proportional Hazards Models, Prospective Studies, Risk Factors, Sepsis, Time Factors}, issn = {1559-6834}, doi = {10.1086/655461}, author = {Auriti, Cinzia and Ronchetti, Maria Paola and Pezzotti, Patrizio and Marrocco, Gabriella and Quondamcarlo, Anna and Seganti, Giulio and Bagnoli, Francesco and De Felice, Claudio and Buonocore, Giuseppe and Arioni, Cesare and Serra, Giovanni and Bacolla, Gianfranco and Corso, Giovanna and Mastropasqua, Savino and Mari, Annibale and Corchia, Carlo and Di Lallo, Domenico and Rav{\`a}, Lucilla and Orzalesi, Marcello and Di Ciommo, Vincenzo} }