1、Morgan Stanley Childrens Hospital Columbia University,Richard A. Polin M.D.,Hospital Acquired infections,Outline,Clinical significance of hospital acquired infections Epidemiology of bacterial and fungal hospital acquired infections Management of coagulase negative staphylococcal “infections” Strate

2、gies for prevention,Background,Sepsis in newborn infants has traditionally been classified as: early onset sepsis ( 3 days) and very late onset sepsis ( 60 days after birth) Late onset infections that occur during the course of prolonged hospitalizations (healthcare associated infections) represent

3、the largest category of neonatal infections,Early-Onset2%,Late-Onset20%,Birth 3d,30d,60d,90d,Very Late-Onset 1%,Timing of infection in VLBW infants,Why Worry about Hospital-acquired infections?,There are 2,000,000 nosocomial infections in the U.S. each year 50-60% are caused by resistant bacteria La

4、te onset sepsis is responsible for up to 45% of deaths after two weeks of age HAIs prolong hospitalization, increase costs and are associated with a poorer neurodevelopmental outcome,Adverse Neurodevelopmental Outcome in ELBW Infants with Infections,Stoll et al JAMA 292: 2357, 2004 (n=6093, 18 month

5、 follow-up),Clinical infection Sepsis Sepsis + NEC(n=1538) (n=1922) (n=279) MDI 70 1.3 (CI 1.1,1.5) 1.3 (CI 1.1,1.6) 1.6 (CI 1.2,2.2) PDI 70 1.5 (CI 1.3,2.0) 1.5 (CI 1.2,1.9) 2.4 (CI 1.7,3.4) CP 1.3 (CI 1.0,1.6) 1.4 (CI 1.1,1.8) 1.7 (CI 1.2,2.5) Microcephaly 1.3 (CI (1.1,1.6) 1.5 (CI 1.2,1.7) 2.0 (C

6、I 1.5, 2.6),Birth weight (gm)UV however a peripheral blood culture may also get contaminated. Quantitative blood cultures may help distinguish contaminated blood cultures from true infections, but are not commonly used.,Treatment of Coagulase Negative Staphylococcal Bacteremia,Clinical Signs and Sym

7、ptoms of Sepsis,Draw a central and peripheral blood culture and begin broad antibiotics,Peripheral negative Central negative,Presumed colonization,Peripheral positiveCentral negative,Presumed contamination D/C antibiotics by 48 hours if signs resolve,Peripheral negativeCentral positive,Peripheral po

8、sitiveCentral positive,Discontinue antibi-otics by 48 hours,CONS bacteremia,Continue vancomycin 111:e519-e533,Rates of coagulase negative staphylococcal bacteremia at the collaborative institutions before and after interventions,Percent of Patients Infected with CONS,Collaborating Centers,97,00,Cent

9、ers: 123456All,Aly, H. et al. Pediatrics 2005;115:1513-1518,Annual Rates of Central Line-Related Blood Stream Infectionsat George Washington University Hospital,Infection/1000 line days,Conclusions,Nosocomial sepsis is an immense problem (worldwide) that increases mortality and morbidity and adds tens of millions o