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Analysis of bacterial infections in a neonatal intensive care unit
Letters to the Editor
90
Pseudobacteraemias (40) due to non-fermentative Gram-negative 1982)
Citrate-associated
Not apparently citrate-associated
25
8
bacilli (April 1981-October
Not known 7
In at least five out of 25 citrate-associated pseudobacteraemias the venesectionists concerned claimed to have inoculated the blood culture bottles first. Whilst most of our pseudobacteraemias are citrate-associated it does leave some cases for which we have no explanation, but suggest could be due to short-term hand carriage after handling ESR bottles. It would be most interesting to learn of anyone who has changed to a system which uses sterile citrate for ESR investigations and who can give figures of pseudobacteraemias before and after such change. P. A. Willson,
Mrs S. L. Baker and D. N. Petts
Department of Microbiology, Basildon Hospital, Basildon Essex SS16 5NL References Haji, T. C., Sanderson, P. J., Sangam, A., Willmot, I. C. (1982). Blood culture procedure and contamination with serratia. Journal of Hospital Infection 3, 312-313. Willson, P. A., Petts, D. N., Baker, S. L. (1981). An outbreak of pseudobacteraemia British Medical Journal ii, 866.
Sir, Analysis
of bacterial
infections
in a neonatal
intensive
care unit
In the September issue of the Journal Dr Hoogkamp-Korstanje and co-workers (1982) analysed all cases of infection among 181 neonates admitted to the neonatal intensive care unit during one year, Thirty per cent acquired a hospital infection. They conclude that most hospital infections were nosocomial and not auto-infections. Apart from the fact that the term nosocomial infections means both the exogenous and endogenous (‘auto-infection’) origin, the results of their study differ significantly from those of previous large studies, which they did not discuss in their paper (Table I). Surface infections, such as infections of the skin, intravenous therapy site infections, oral or conjunctival infections, pyoderma, cutaneous abscessesand omphalitis, were by far the most common infections in newborns in three of the studies. Hoogkamp-Korstanje et al. recorded fewer skin
Letters to the Editor
91
Table I. Nosocomial infections in newborn intensive care units First author Number of patients Total. nosocomial infection rate (%) Re~;ivc~osocomral infection rate (%) P:eumonia Bacteremia Surgical wound infection Urinary tract infection Meningitis Others
Hemming
Maguire
Daschner
HoogkampKorstanje
904 24.6
824 16.9
672 23.9
181 30.4
40.1 29.3 14.0 8.1 4.5 4.0 -
45.1 18.6 15.9
44.7 3.7 14.3
26.3 34.4 20.8
Ti
;:;
1G
2.7 13.3
236.:
<3
infections, but a significantly higher rate of pneumonia and urinary tract infections. The reason for this remains unclear from their presentation. In contrast to adult patient populations, urinary tract infections do not seem to play a significant role in children, especially newborn babies. This is mainly due to the fact that children and newborn infants are rarely catheterized. The paper also lacks data on staffing, patient-care practices, isolation procedures, and other factors related to the possible spread of infection in their hospital, which might at least partly account for the differences in infection rates compared to previous investigations. Goldmann, Durbin and Freeman (1981) and Haley and Bregman (1982) convincingly demonstrated that understaffing, overcrowding and badly-designed facilities are important in increasing cross infection in neonatal intensive care units. F. Daschner
Klinikum
der Albert-LudwigsUniversitci’t Freiburg, West Germany
References Daschner, F., Saal, E. & Pringsheim, W. (1981). Krankenhausinfektionen in einer Neugeborenen-Intensivpflegestation. Intensivbehandlung 6, 81-85. Goldmann, D. A., Durbin, W. A. Jr & Freeman, J. (1981). Nosocomial infections in a neonatal intensive care unit. The Journal of Infectious Diseases 144, 449-459. Haley, R. W. & Bregman, D. A. (1982). Th e role of understaffiing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. The Journal of Infectious Diseases 145, 875-885. Hemming, V. G., Overall, J. C. Jr & Britt, M. R. (1976). Nosocomial infections in a newborn intensive care-unit. Results of fourty-one months of surveillance. The New EnglandJournal of Medicine 294, 1310-1343. Hoogkamp-Korstanje, J. A. A., Cats, B., Senders, R., Ch. & van Ertbruggen I. (1982). Analysis of bacterial infections in a neonatal intensive care unit. The Journal of Hospital Infection 3, 275-284. Maguire, G. C., Nordin, J., Meyers, M. G., Koontz, F. P., Hierholzer, W. 8r Nassif, E. (1981). Infections acquired by young infants. American Journal of Diseases of Children 135,693-698.
90
Pseudobacteraemias (40) due to non-fermentative Gram-negative 1982)
Citrate-associated
Not apparently citrate-associated
25
8
bacilli (April 1981-October
Not known 7
In at least five out of 25 citrate-associated pseudobacteraemias the venesectionists concerned claimed to have inoculated the blood culture bottles first. Whilst most of our pseudobacteraemias are citrate-associated it does leave some cases for which we have no explanation, but suggest could be due to short-term hand carriage after handling ESR bottles. It would be most interesting to learn of anyone who has changed to a system which uses sterile citrate for ESR investigations and who can give figures of pseudobacteraemias before and after such change. P. A. Willson,
Mrs S. L. Baker and D. N. Petts
Department of Microbiology, Basildon Hospital, Basildon Essex SS16 5NL References Haji, T. C., Sanderson, P. J., Sangam, A., Willmot, I. C. (1982). Blood culture procedure and contamination with serratia. Journal of Hospital Infection 3, 312-313. Willson, P. A., Petts, D. N., Baker, S. L. (1981). An outbreak of pseudobacteraemia British Medical Journal ii, 866.
Sir, Analysis
of bacterial
infections
in a neonatal
intensive
care unit
In the September issue of the Journal Dr Hoogkamp-Korstanje and co-workers (1982) analysed all cases of infection among 181 neonates admitted to the neonatal intensive care unit during one year, Thirty per cent acquired a hospital infection. They conclude that most hospital infections were nosocomial and not auto-infections. Apart from the fact that the term nosocomial infections means both the exogenous and endogenous (‘auto-infection’) origin, the results of their study differ significantly from those of previous large studies, which they did not discuss in their paper (Table I). Surface infections, such as infections of the skin, intravenous therapy site infections, oral or conjunctival infections, pyoderma, cutaneous abscessesand omphalitis, were by far the most common infections in newborns in three of the studies. Hoogkamp-Korstanje et al. recorded fewer skin
Letters to the Editor
91
Table I. Nosocomial infections in newborn intensive care units First author Number of patients Total. nosocomial infection rate (%) Re~;ivc~osocomral infection rate (%) P:eumonia Bacteremia Surgical wound infection Urinary tract infection Meningitis Others
Hemming
Maguire
Daschner
HoogkampKorstanje
904 24.6
824 16.9
672 23.9
181 30.4
40.1 29.3 14.0 8.1 4.5 4.0 -
45.1 18.6 15.9
44.7 3.7 14.3
26.3 34.4 20.8
Ti
;:;
1G
2.7 13.3
236.:
<3
infections, but a significantly higher rate of pneumonia and urinary tract infections. The reason for this remains unclear from their presentation. In contrast to adult patient populations, urinary tract infections do not seem to play a significant role in children, especially newborn babies. This is mainly due to the fact that children and newborn infants are rarely catheterized. The paper also lacks data on staffing, patient-care practices, isolation procedures, and other factors related to the possible spread of infection in their hospital, which might at least partly account for the differences in infection rates compared to previous investigations. Goldmann, Durbin and Freeman (1981) and Haley and Bregman (1982) convincingly demonstrated that understaffing, overcrowding and badly-designed facilities are important in increasing cross infection in neonatal intensive care units. F. Daschner
Klinikum
der Albert-LudwigsUniversitci’t Freiburg, West Germany
References Daschner, F., Saal, E. & Pringsheim, W. (1981). Krankenhausinfektionen in einer Neugeborenen-Intensivpflegestation. Intensivbehandlung 6, 81-85. Goldmann, D. A., Durbin, W. A. Jr & Freeman, J. (1981). Nosocomial infections in a neonatal intensive care unit. The Journal of Infectious Diseases 144, 449-459. Haley, R. W. & Bregman, D. A. (1982). Th e role of understaffiing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. The Journal of Infectious Diseases 145, 875-885. Hemming, V. G., Overall, J. C. Jr & Britt, M. R. (1976). Nosocomial infections in a newborn intensive care-unit. Results of fourty-one months of surveillance. The New EnglandJournal of Medicine 294, 1310-1343. Hoogkamp-Korstanje, J. A. A., Cats, B., Senders, R., Ch. & van Ertbruggen I. (1982). Analysis of bacterial infections in a neonatal intensive care unit. The Journal of Hospital Infection 3, 275-284. Maguire, G. C., Nordin, J., Meyers, M. G., Koontz, F. P., Hierholzer, W. 8r Nassif, E. (1981). Infections acquired by young infants. American Journal of Diseases of Children 135,693-698.