Objectives: To identify factors that are associated with an increased risk of nosocomial enterococcal infection in children.
Methods: A matched case-control study was conducted between January 1989 and July 1993 at the Children's National Medical Center, Washington DC. One control patient for each case was identified. Control patients did not have nosocomial enterococcal infections and were matched with cases on the basis of age and time of admission closest to the case within a three-month period. Data were collected from systematic review of patient medical records. One hundred and one study patients (cases) were matched with 101 control patients. A case was defined as a patient with enterococcal infection who met the Centers for Disease Control and Prevention criteria for nosocomial infection. Microbiology methods included isolation, identification, and antimicrobial susceptibility testing of enterococci from clinical specimens.
Results: Risk factors associated with nosocomial enterococcal infections were determined by multiple conditional logistic regression analyses of the cases and controls. Factors identified were placement of a central line, gastrointestinal tract pathology, and administration of multiple antimicrobial agents. The median duration of antimicrobial therapy prior to diagnosis of nosocomial enterococcal infection was approximately 1 week.
Conclusion: The incidence of nosocomial enterococcal infections in children may be controlled by limiting the number of antimicrobial agents administered to hospitalized high risk patients. The importance of our findings is relevant in an era of increasing rates of antimicrobial resistance in nosocomial enterococcal infections.