1887

Abstract

Intestinal nosocomial infections remain a major concern in paediatric wards leading to increased morbidity and mortality. This study determined the aetiological and epidemiological profile of nosocomial diarrhoea (ND) among children admitted to a hospital in India. During the period of January 2008 to June 2009, we consecutively enrolled 100 children between the age of 2 months and 14 years who developed ND as defined by the Centers for Disease Control and Prevention. A control group of patients matched for age and severity score but with no diarrhoea at admission or during their hospital stay ( = 50) were also enrolled. Stool samples were cultured for various pathogens using standard protocols. toxins and rotavirus antigen were detected using commercial ELISAs. Detection of diarrhoeagenic was carried out by multiplex PCR assay. All patient details were noted. In this study, males predominated (77 %), and 56 % children were <1 year of age and 96 % were <5 years. The mean duration of diarrhoea and hospitalization in the case group was 3.2 days and 27.5 days, respectively. Malignancy and nasogastric tube usage were significant underlying factors for the development of ND. Diarrhoeagenic was the commonest agent (47 %: enterotoxigenic , enteroaggregative and enteropathogenic were isolated in 22, 18 and 7 % of patients, respectively). toxin was seen in 9 % of cases, whilst rotavirus was found in 8 % of cases. Although rotavirus and are major causative agents of hospital-acquired diarrhoea in the developed world, in this setting diarrhoeagenic was responsible for the majority of cases of hospital-acquired diarrhoea. ND was most common in children aged <5 years.

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2012-06-01
2020-01-23
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References

  1. Alrifai S. B. , Alsaadi A. , Mahmood Y. A. , Ali A. A. , Al-Kaisi L. A. . ( 2009; ). Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital. . East Mediterr Health J 15:, 1111–1118.[PubMed]
    [Google Scholar]
  2. Barnes G. L. , Bishop R. F. , Townley R. R. . ( 1974; ). Microbial flora and disaccharidase depression in infantile gastroenteritis. . Acta Paediatr Scand 63:, 423–426. [CrossRef] [PubMed]
    [Google Scholar]
  3. Boyer K. M. , Petersen N. J. , Farzaneh I. , Pattison C. P. , Hart M. C. , Maynard J. E. . ( 1975; ). An outbreak of gastroenteritis due to E. coli 0142 in a neonatal nursery. . J Pediatr 86:, 919–927. [CrossRef] [PubMed]
    [Google Scholar]
  4. Brady M. T. , Pacini D. L. , Budde C. T. , Connell M. J. . ( 1989; ). Diagnostic studies of nosocomial diarrhea in children: assessing their use and value. . Am J Infect Control 17:, 77–82. [CrossRef] [PubMed]
    [Google Scholar]
  5. Chakraborty S. , Deokule J. S. , Garg P. , Bhattacharya S. K. , Nandy R. K. , Nair G. B. , Yamasaki S. , Takeda Y. , Ramamurthy T. . ( 2001; ). Concomitant infection of enterotoxigenic Escherichia coli in an outbreak of cholera caused by Vibrio cholerae O1 and O139 in Ahmedabad, India. . J Clin Microbiol 39:, 3241–3246. [CrossRef] [PubMed]
    [Google Scholar]
  6. CLSI ( 2008; ). Performance Standards for Antimicrobial Susceptibility Testing; 18th Informational Supplement. M100-S18. . Wayne, PA:: Clinical and Laboratory Standards Institute;.
    [Google Scholar]
  7. Cobeljić M. , Miljković-Selimović B. , Paunović-Todosijević D. , Velicković Z. , Lepsanović Z. , Zec N. , Savić D. , Ilić R. , Konstantinović S. . & other authors ( 1996; ). Enteroaggregative Escherichia coli associated with an outbreak of diarrhoea in a neonatal nursery ward. . Epidemiol Infect 117:, 11–16. [CrossRef] [PubMed]
    [Google Scholar]
  8. Cutler J. E. , Friedman L. , Milner K. C. . ( 1972; ). Biological and chemical characterization of toxic substances from Candida albicans . . Infect Immun 6:, 616–627.[PubMed]
    [Google Scholar]
  9. Dutta P. , Mitra U. , Rasaily R. , Bhattacharya S. K. , De S. P. , Sen D. , Saha M. R. , Nair G. B. , Niyogi S. K. . & other authors ( 1993; ). Prospective study of nosocomial enteric infections in a pediatric hospital, Calcutta. . Indian Pediatr 30:, 187–194.[PubMed]
    [Google Scholar]
  10. Eisenberg P. . ( 2002; ). An overview of diarrhea in the patient receiving enteral nutrition. . Gastroenterol Nurs 25:, 95–104. [CrossRef] [PubMed]
    [Google Scholar]
  11. Emori T. G. , Culver D. H. , Horan T. C. , Jarvis W. R. , White J. W. , Olson D. R. , Banerjee S. , Edwards J. R. , Martone W. J. . & other authors ( 1991; ). National nosocomial infections surveillance system (NNIS): description of surveillance methods. . Am J Infect Control 19:, 19–35. [CrossRef] [PubMed]
    [Google Scholar]
  12. Garcia L. S. . ( 2001; ). Macroscopic and microscopic examination of fecal specimens. . In Diagnostic Medical Parasitology, , 4th edn., pp. 741–785. Edited by Garcia. L. S. . Washington, DC:: American Society for Microbiology;.
    [Google Scholar]
  13. Garner J. S. , Jarvis W. R. , Emori T. G. , Horan T. C. , Hughes J. M. . ( 1988; ). CDC definitions for nosocomial infections, 1988. . Am J Infect Control 16:, 128–140. [CrossRef] [PubMed]
    [Google Scholar]
  14. Gross R. J. , Rowe B. , Henderson A. , Byatt M. E. , Maclaurin J. C. . ( 1976; ). A new Escherichia coli O-group, O159, associated with outbreaks of enteritis in infants. . Scand J Infect Dis 8:, 195–198.[PubMed] [CrossRef]
    [Google Scholar]
  15. Gupta T. P. , Ehrinpreis M. N. . ( 1990; ). Candida-associated diarrhea in hospitalized patients. . Gastroenterology 98:, 780–785.[PubMed]
    [Google Scholar]
  16. Hammami A. , Arlet G. , Ben Redjeb S. , Grimont F. , Ben Hassen A. , Rekik A. , Philippon A. . ( 1991; ). Nosocomial outbreak of acute gastroenteritis in a neonatal intensive care unit in Tunisia caused by multiply drug resistant Salmonella wien producing SHV-2 β-lactamase. . Eur J Clin Microbiol Infect Dis 10:, 641–646. [CrossRef] [PubMed]
    [Google Scholar]
  17. Hjelt K. , Krasilnikoff P. A. , Grauballe P. C. , Rasmussen S. W. . ( 1985; ). Nosocomial acute gastroenteritis in a paediatric department, with special reference to rotavirus infections. . Acta Paediatr Scand 74:, 89–95. [CrossRef] [PubMed]
    [Google Scholar]
  18. Hughes J. , Jarvis W. . ( 1987; ). Nosocomial gastrointestinal infection. . In Prevention and Control of Nosocomial Infection, pp. 405–439. Edited by Wenzel R. . . Baltimore:: Williams & Wilkins;.
    [Google Scholar]
  19. Jarvis W. R. . ( 1992; ). Yersinia enterocolitica: a new or unrecognized nosocomial pathogen?. Infect Control Hosp Epidemiol 13:, 137–138. [CrossRef] [PubMed]
    [Google Scholar]
  20. Kamalaratnam C. N. , Kang G. , Kirubakaran C. , Rajan D. P. , Daniel D. J. , Mathan M. M. , Mathan V. I. . ( 2001; ). A prospective study of nosocomial enteric pathogen acquisition in hospitalized children in South India. . J Trop Pediatr 47:, 46–49. [CrossRef] [PubMed]
    [Google Scholar]
  21. Kim S. W. , Peck K. R. , Jung S. I. , Kim Y. S. , Kim S. , Lee N. Y. , Song J. H. . ( 2001; ). Pseudomonas aeruginosa as a potential cause of antibiotic-associated diarrhea. . J Korean Med Sci 16:, 742–744.[PubMed] [CrossRef]
    [Google Scholar]
  22. Koneman E. , Allen D. , Janda W. , Schreckenberger P. , Winn W. . ( 1997; ). Color Atlas and Textbook of Diagnostic Microbiology, , 5th edn.. Philadelphia:: Lippincott;.
    [Google Scholar]
  23. Lam B. C. , Tam J. , Ng M. H. , Yeung C. Y. . ( 1989; ). Nosocomial gastroenteritis in paediatric patients. . J Hosp Infect 14:, 351–355. [CrossRef] [PubMed]
    [Google Scholar]
  24. Langley J. M. , Hanakowski M. , Golubeva O. . ( 1999; ). Changing etiology of nosocomial diarrhea in a pediatric hospital. . In Interscience Conference on Antimicrobial Agents and Chemotherapy, p. 614. Dalhousie University, Halifax, NS, Canada.
    [Google Scholar]
  25. Nguyen T. V. , Le Van P. , Le Huy C. , Gia K. N. , Weintraub A. . ( 2005; ). Detection and characterization of diarrheagenic Escherichia coli from young children in Hanoi, Vietnam. . J Clin Microbiol 43:, 755–760. [CrossRef] [PubMed]
    [Google Scholar]
  26. Paton S. , Nicolle L. , Mwongera M. , Kabiru P. , Mirza N. , Plummer F. , Wamola I. . ( 1991; ). Salmonella and Shigella gastroenteritis at a public teaching hospital in Nairobi, Kenya. . Infect Control Hosp Epidemiol 12:, 710–717. [CrossRef] [PubMed]
    [Google Scholar]
  27. Pépin J. , Valiquette L. , Alary M. E. , Villemure P. , Pelletier A. , Forget K. , Pépin K. , Chouinard D. . ( 2004; ). Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. . CMAJ 171:, 466–472. [CrossRef] [PubMed]
    [Google Scholar]
  28. Pollack M. M. , Ruttimann U. E. , Getson P. R. . ( 1988; ). Pediatric risk of mortality (PRISM) score. . Crit Care Med 16:, 1110–1116. [CrossRef] [PubMed]
    [Google Scholar]
  29. Ryder R. W. , Rahman A. S. , Alim A. R. , Yunis M. D. , Houda B. S. . ( 1986; ). An outbreak of nosocomial cholera in a rural Bangladesh hospital. . J Hosp Infect 8:, 275–282. [CrossRef] [PubMed]
    [Google Scholar]
  30. Schmidt H. , Knop C. , Franke S. , Aleksic S. , Heesemann J. , Karch H. . ( 1995; ). Development of PCR for screening of enteroaggregative Escherichia coli . . J Clin Microbiol 33:, 701–705.[PubMed]
    [Google Scholar]
  31. Thuret A. , Patural H. , Berthelot P. , Benzait F. , Martin I. , Jusot J.-F. , Teyssier G. , Fabry J. , Pozzetto B. . Pédiatres des Services Participant à L’étude ( 2004; ). [Prospective follow-up of hospital-acquired diarrhoea in 28 paediatric wards of the south-east part of France during a winter season]. . Pathol Biol (Paris) 52:, 131–137 (in French). [CrossRef] [PubMed]
    [Google Scholar]
  32. Toma C. , Lu Y. , Higa N. , Nakasone N. , Chinen I. , Baschkier A. , Rivas M. , Iwanaga M. . ( 2003; ). Multiplex PCR assay for identification of human diarrheagenic Escherichia coli . . J Clin Microbiol 41:, 2669–2671. [CrossRef] [PubMed]
    [Google Scholar]
  33. Uppal B. , Wadhwa V. , Mittal S. K. . ( 2004; ). Nosocomial diarrhea. . Indian J Pediatr 71:, 883–885. [CrossRef] [PubMed]
    [Google Scholar]
  34. Yolken R. H. , Bishop C. A. , Townsend T. R. , Bolyard E. A. , Bartlett J. , Santos G. W. , Saral R. . ( 1982; ). Infectious gastroenteritis in bone-marrow-transplant recipients. . N Engl J Med 306:, 1010–1012. [CrossRef] [PubMed]
    [Google Scholar]
  35. Zaidi M. , Ponce de León S. , Ortiz R. M. , Ponce de León S. , Calva J. J. , Ruiz-Palacios G. , Camorlinga M. , Cervantes L. E. , Ojeda F. . ( 1991; ). Hospital-acquired diarrhea in adults: a prospective case-controlled study in Mexico. . Infect Control Hosp Epidemiol 12:, 349–355. [CrossRef] [PubMed]
    [Google Scholar]
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