Nosocomial infections are one of significant causes of morbidity and mortality. Evaluating risk factors to predict nosocomial infection is important to improve clinical outcomes. We aimed to evaluate the accuracy of risk factors to predict nosocomial infections in children.
A prospective cohort study was conducted during 28 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to the Pediatric ICU and pediatric wards >48 hours were eligible. Those eligible patients were observed daily to identify the presence of nosocomial infection based on Centers for Disease Control and Prevention (CDC) criteria. The risk factors of nosocomial infections were identified. Logistic regression was used to identify independent predictors and assigned the risk score (value). We then computed the score for each patient and chose the cutoff value of score. We finally performed a receiver operating characteristic (ROC) curve analysis and computed the area under the curve (AUC).
Total of 2646 patients were recruited. Of 400 were diagnosed as nosocomial infections. The cumulative incidence of nosocomial infection was 15.1%. In multivariate analysis; length of stay >7 days, suffered from syndrome, use of central venous line (CVL), urine catheter, mechanical ventilation, and exposed to irrational antibiotics were independently associated with increased risk of nosocomial infections with adjusted OR (95%CI): 22.46(14.73-34.26), 1.98(1.33-2.93), 2.45(1.18-5.08), 3.56(2.34-5.40), 2.50(1.57-3.99), and 2.13(1.58-2.87), respectively. A score of these risk factors accurately predicts nosocomial infections with the area under ROC curve of 0.86.
This study proves that length of stay >7 days, syndrome, use of CVL, urine catheter, mechanical ventilation, and irrational antibiotics increased risk of nosocomial infections in children. The score of these risk factors accurately predicts nosocomial infections.
Key words: risk factor, nosocomial infection, children, developing countries, Indonesia