INCIDENCE OF NOSOCOMIAL BLOOD STREAM INFECTION, PNEUMONIA AND URINARY TRACT INFECTION INPEDIATRIC WARD AT KING ABDULAZIZ UNIVERSITY HOSPITAL, JEDDAH, SAUDI

Osama Y. Safder, Mohammed S. Alzahrani, Wafaa F. Alharbi, Hassan K. Balubaid, Mohammed F. Bukhari, Bashaer S. Alshomrany, Barah A. Malibari, Nada J. Alata, Manayer G. ALmutairi and AbeerAlnajjar. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Introduction:-
Nosocomial infections (NI): "defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation" (1). NI are a Major complication in pediatric patients at different hospital wards. NI are associated with significant morbidity and mortality. Studies had shown that nosocomial infection is strongly associated with prolonged hospital stay and increase the economic burden on the health care system (2). Many studies had shown that the most common organisms are gram-negative bacteria as Klebsiella pneumonia, E-coli, and pseudomonas aeruginosa, followed by gram positive bacteria as staphylococcus aureus, and enterococci (3). The most common type of infections are blood stream infection, followed by pneumonia, and UTI (4). There are multiple risk factors that precipitate NI as prolonged hospital stay, and patients who are admitted to ICU are more prone to have NI (5). Patients who are on mechanical ventilation device, central venous line, or urinary catheter are at higher risk to develop NI. (6) In Tunisia, a prospective cohort study was done and showed over all incidence of NI is (6.5%), mostly caused by Gram-negative bacteria (68%) with Klebsiella pneumonia accounting (22.7%), the commonest type is BSI (7). On the other hand, in a multicenter European prospective study showed that the overall incidence of NI is (2.5%), mostly caused by bacteria accounting for (68%). Most of these bacteria are gram negative bacilli but, that coagulase negative staphylococcus is the main pathogen. The same study showed that antibiotic resistant was highest in PICU compared to the general pediatric unit. (8) Locally, at Al-Hada Armed Forces Hospital in Taif, Saudi Arabia during the year 2004. A prospective study was for all patients admitted there. The most common site of infection was pneumonia (32.3%), followed by urinary tract infection (UTI) (25.7%) and blood stream infections (BSI) (18.6%). The most common organism was Gram negative (66.2%). E.coli was the most common organism (22.3%) (9). Statistical analysis:In the present study, statistical analysis using "IBM SPSS statistics ver. 20.0" was applied to evaluate and test the hypothesis.

Research objectives:-
Descriptive statistics, charts (Frequencies and percentage ) . study tools: a data gathered by hospital system using a data sheet with include demographics, date of admission, date of discharge, comorbidity, diagnosis, length of stay, investigation (on admission, with infection, after infection) imaging, medication, risk factor(blood transfusion, immunosuppressant medication, stress ulcer prophylaxis ,central line, PICC line, NGT, TPN, urinary catheter, ventilator, tracheostomy ), outcome.

Results:-
The total number of patients who admitted between 15 February 2015 to 16 February 2016 was 1502 patients, 111 patients got a nosocomial infection.
Among the different age groups, the Infants are more reliable to have a nosocomial infection by (62.2%).The patient who had an underlying cardiovascular disease (18.9%) are more susceptible to has a nosocomial infection, followed by a neurological disease (16.2%) and gastrointestinal disease (16.2%). The most common type of infections in this study was UTI (25.2%) followed by blood stream infection (21.6%), pneumonia (19.8%).
The three most potential predisposing factors were Immunosuppressive medications ( 22.5%), Central venous catheter (22.5%) and Nasogastric tube (19.8%). This study also showed that increase length of stay may increase the chance to get a nosocomial infection.
The majority of patients recovered within one week (57.7%). the mortality were only (3.6%).

Discussion:-
The goals of the study were to know the most common organism that cause nosocomial infection, most common site of infection and the risk factors. Coagulase-negative staphylococci was the most common infection which present (25.3%) of our samples.
Coagulase-negative staphylococci are part of normal flora of the human skin, and it can be transmitted throw any invasive devises to the blood and cause infection, that's why it'sthe most common infection in hospitals.
A study of 24,179 cases of nosocomial in 49 hospitals across the United States suggest that (31%) of sample were coagulase negative staphylococci (11).
But on the other hand, a study of 841 patients done in tertiary care teaching hospital showed that klebisiella pneumonia was predominant (12).
The data indicate that the UTI is the most common site of infection.
A study done in United States, 110709 pediatric patients with 6290 nosocomial infections suggest that the blood stream infection is more frequently than UTI (13).
Prolonged hospital stay and frequently used of invasive devices with poor hygiene can cause hospital acquired infection and may cause complication such as sepsis and maybe death .
Immunosuppressive medication,central venous catheter and nasogastric tubeare most common predisposing factors. Study of 911 cases was performed at St Louis Children's Hospital, showed thatpatients with bloodstream infection were more likely to have multiple central venouscatheters (14).On the other hand, in Egypt, there is a study conducted in devises associated infection, they found that the Patients who are on mechanical ventilation device, central venous line, or urinary catheter are at higher risk to develop NI (6). But in our study we found that Patients who are on central venous line, peripherally inserted catheter and Nasogastric tube are at higher risk to develop NI.

Conclusion:-
Infant patients are more reliable to get a Nosocomial infection than the other pediatric age groups. In this study, the UTI is the commonest type of infection. Gram negative organisms are the most common to cause an NI but, the Coagulase-negative staphylococci is the common organism. Immunosuppressive medications, Central venous catheter and Nasogastric tube are the three most potential predisposing factors. The majority of patients recovered within one week.

Perspectives:-
We believe that we need further similar studies with multicenter and larger sample size. Also, a control group that involves patients with a non-nosocomial fever might help to understand the possible risk factors for the development of nosocomial infection.