Unique epidemiology of nosocomial urinary tract infection in children

Background: Nosocomial urinary tract infection (NUTI) occurs with varying frequency in children and is thought to be associated with urethral instrumentation. In response to changing infection control resources at our facility, we reviewed NUTI to determine whether the frequency of NUTI, associated complications, or presence of a remediable risk factor (instrumentation) justified ongoing routine infection control surveillance. Methods: Prospective surveillance was conducted on all wards 8 months per year from January 1991 through December 1997 by an infection control nurse coordinator. NUTI was defined by laboratory evidence according to Center for Disease Control and Prevention definitions and detected 48 hours after admission. Urinary catheterization in the previous 7 days was categorized as continuous/indwelling or intermittent. Results: NUTI was the fifth most common nosocomial infection (129/1375: similar to9%) and decreased in frequency during the decade from 0.9 to similar to0.6 cases/1000 patient days. Incidence was equal among men and women. Only 50% of cases had prior instrumentation of the urinary tract. NUTI occurred disproportionately in newborns and infants (P <.001). The most common pathogen was Escherichia coli (28%: 38/132), followed by Candida sp (18%; 24/134), Enterococcus (13%; 18/134), gram-negative nonfermenters (13%; 17/132), Enterobacter (<similar to>10%; 13/134), Pseudomonas (9.7%; 13/134), and other (16%; 22/134). Three cases of secondary bacteremia occurred (2.3%; 95% confidence interval 0.5-6.6); there was no mortality. Conclusions: NUTI poses a less significant burden of illness (incidence, associated morbidity) than other nosocomial infection in children. If resources do not permit hospital-wide surveillance; high-risk children with urethral instrumentation and newborns and infants could be targeted. Although E coli remains the most common cause of pediatric NUTI, fungi have become the second most common pathogen in this tertiary care population. Risk factors for NUTI in noncatheterized children remain to be delineated.