Nosocomial Bloodstream Infection in Pediatric Patients: Siriraj Hospital, Bangkok; 1996-1999
KANOKPORN MONGKOLRATTANOTHAI, M.D.*, KULKANYA CHOKEPHAIBULKIT, M.D.*,
THARATHIP KOLAT AT, M.D.*, NIRUN VA NPRAPAR, M.D.*,
SANAY CHEARSKUL, M.D.*, NITAYA SRIHAPOL, R.N.**,
VARAPORN PUMSAWAN,R.N.**, SUMALEE PAKAW ORAW UTH, R.N.**,
CHERTSAK DIDRAPUTRA, M.D.***
Affiliation : * Department of Pediatrics,
** Center of Nosocomial Infectious Control,
*** Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
AbstractA retrospective study on nosocomial bloodstream infection (NBSI) in pediatric
patients hospitalized at Siriraj Hospital from January 1996 to December 1999 was performed.
Of the 18,087 blood specimens sent for culture, 533 (3%) were positive for organisms after
72 hours of hospitalization and were defined as NBSI. The rate of NBSI detected in
blood culture specimens was highest among neonates (5.2% ). Gram-positive cocci and
gram-negative rods caused NBSI in an equal proportion ( 46% and 44% respectively)
and Candida caused 10 per cent of NBSI. Coagulase-negative staphylococci was the
most common pathogen followed by K. pneumoniae and Enterobacter. Antibiogram showed
that 15 of the 35 (43%) S. aureus identified were methicillin-resistant. Only 35-38 per cent
of Enterobacteriaceae were sensitive to cefotaxime or ceftazidime. Cefoxitin was still
effective against 95 per cent of K. pneumoniae. Compared with other third generation
cephalosporins, combination of cefoperazone and betalactamase-inhibitor (sulbactam)
possessed an increased in vitro efficacy against K. pneumoniae, Enterobacter, E. coli,
Acinetobacter and non-fermentative gram-negative rods. Resistant rate of amikacin among
all gram negative rods was 25-69 per cent. Ciprofloxacin sensitivity varied from 62-100
per cent among all gram-negative rods. Imipenem was excellent against all gram-negative
rods with the sensitivity of 80-100 per cent. Epidemiological data of this study is important
for the decision of the appropriate empirical antimicrobial treatment in our hospital.
Keywords : Nosocomial, Bacteremia, Thai Children, Bloodstream Infection
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