Pediatric nosocomial infections: children are not little adults.

This issue of Infection Control and Hospital Epidemiology contains articles that highlight pediatric nosocomial infections. Current strategies for surveillance, prevention, and control of nosocomial infections have focused on general hospital services that primarily address the needs of adult patient populations. Although some of these strategies apply to infants and children, it is clear that pediatric patients and pediatric units are unique and require childspecific prevention and control plans. The following areas are critical for development of appropriate intervention strategies and will be the focus of this discussion: (1) surveillance methods appropriate to identify and analyze nosocomial infection rates in pediatric facilities; (2) guideline development based on reservoirs of infection, host-pathogen interactions, and modes of transmission in the pediatric patient population; (3) prevalence of resistant organisms and the use of antimicrobials in pediatric acuteand non—acute-care settings. The concept that pediatric nosocomial infections differ from those in adults has been well established. In the early 1980s, the National Nosocomial Infection Surveillance (NNIS) Systems reported that pediatric services had lower rates of infection than other hospital services; however, Ford-Jones and others in the late 1980s found a substantially higher nosocomial infection rate in children (6-7 infections/100 patients) than adults (4/100 patients) when viral infections and sites such as gastrointestinal and upper respiratory infections were included.2 Although children have fewer wound infections, nosocomial pneumonias (ventilator-associated), and urinary tract infections than adults, they have more viral respiratory and viral gastrointestinal infections, bacteremias, and cutaneous infections.3 Multiple factors contribute to the differences in nosocomial infections of infants and young children and nosocomial infections of adults, including host factors, sources of infection, routes of transmission, and distribution of pathogens.4 Host factors of particular importance that put young children at risk for nosocomial infection are immaturity of the immune system (especially in newborns and premature infants) and congenital anomalies. Premature infants are at high risk, as they have the most immature immune systems and require prolonged hospitalizations and invasive procedures. The rates of nosocomial infections in neonatal intensive-care units (NICUs) have been reported to be as high as 7% to 25%.2,5 Children with congenital anomalies have a high risk of infection, not only from immune deficiencies related to specific syndromes (eg, Wiskott-Aldrich) but also because of loss of protective host factors such as anatomic barriers to infection (eg, cleft palate and meningomyelocele). These children require multiple hospitalizations, increased numbers of devices, multiple surgeries, and prolonged lengths of stay.6 In addition to sources of nosocomial infections common to all patients (invasive monitors, medical devices, other patients, and hospital personnel), the infant and young child are exposed to specific sources of infection including maternal infections; contaminated breast milk and infant formula; visitors to the hospital, including siblings; and contaminated fomites, such as toys shared with other patients on the units.