Original Article

Frequency and etiology of nosocomial infections in a pediatric intensive care unit

Amer Custovic1, Jasmina Smajlovic2, Edin Husaric3, Rahima Jahic4, Fejzo Dzafic2, Omer C. Ibrahimagic5

1Department of Hygienic and Epidemiological Surveillance, University Clinical Center Tuzla, Bosnia and Herzegovina
2nstitute of Microbiology, Polyclinic for Laboratory Diagnostics, University Clinical Center Tuzla, Bosnia and Herzegovina
3Clinic for Children's Diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
4Clinic for Infectious Diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
5Clinic of Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina


Background: Pediatric intensive care units (PICUs) are specialized clinical departments for the treatment of critically ill newborns, children, and adolescents. Children are susceptible to contracting nosocomial infections (NIs), especially when exposed to an extended hospital stay, severe surgery, or invasive procedures. The main aim of this research was to determine the frequency and etiology of NIs in the PICU of the University Clinical Center Tuzla.
Methods: A total of 303 children admitted to the PICU was followed prospectively for NI development (January-December 2015). Classification of infection as NI was done using the Centers for Disease Control and Prevention (CDC) definition criteria.
Results: Based on continuous epidemiological surveillance, the NI incidence rate (9.24%) was determined. The most prevalent were respiratory and other infections (omphalitis, eye, and ear infections) at an equal frequency of 39.29%, followed by bacteremia in 14.28% cases, while surgical site and urinary infections were present in 3.57% cases, each. Acinetobacter baumannii was the most common cause of nosocomial infections (57.14%). Other causative agents were Klebsiella pneumoniae (14.29%), Pseudomonas aeruginosa (7.14%), then Escherichia coli, Citrobacter kolerii, and Enterobacter cloacae at 3.57%, each. Of Gram-positive bacteria, methicillin- resistant Staphylococcus aureus (MRSA) was identified as the causative agent of NIs (10.72%).
Conclusions: Performing epidemiological surveillance on the frequency and etiology revealed that the most common NIs in our PICU were respiratory and other infections, most often caused by Gram-negative bacteria. These kinds of studies provide an overview of the local and contribute to the knowledge of the global situation, detection of potential clusters, and risk-factors for NI development. Continuous active epidemiological surveillance is needed to further guide the selection of prevention and suppression

Keywords: epidemiological surveillance; nosocomial infections; pediatric intensive care units