Prospective cohort study.
Teaching paediatric hospital—Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast Brazil.
378 of 536 infants admitted in paediatric wards from April to October 2009 were daily assessed during hospital stay until the first episode of nosocomial diarrhoea (ND), death or discharge. Infants with community-acquired diarrhoea, respiratory or haemodynamic instability and who stayed in hospital for <24 h were excluded.
Primary and secondary outcome measures
Incidence and risk factors for ND and rates of pacifier faecal contamination.
33 ND episodes occurred in 378 infants, with a cumulative incidence of 8.7% and density of 11.25/1000 patients-day. ND occurred in 8.2% (16/194) of pacifier users compared with 9.2% (17/184) in non-users (adjusted OR=0.88, 95% CI 0.43 to 1.80). In multivariate logistic regression analysis, duration of oxygen use (OR=1.61; 95% CI 1.18 to 2.20) and days of antimicrobial use (OR=1.62, 95% CI 1.34 to 1.94) were associated with higher risk of ND, whereas being breast fed (OR=0.40, 95% CI 0.17 to 0.93) and each day of hospital stay (OR=0.65, 95% CI 0.53 to 0.80) were protective factors. Faecal coliforms were isolated in 16% (27/169) of tested pacifiers, 77.8% of which had more than 100 000 CFU/ml. The probability of a child remaining free of an episode of diarrhoea up to the seventh day of hospitalisation in the ward was 91.2% (95% CI 87.7% to 94.9%). The log-rank test showed no statistical difference between pacifier users and non-users.
ND is a frequent healthcare-associated infection in paediatric wards, but the use of pacifiers during the stay in hospital does not seem to affect the incidence of ND in infants in many settings where the burden of diarrhoea is still high.
Healthcare-associated infections in paediatric hospital.
Influence of pacifier use and ND in hospitalised children.
Pacifier use is common in paediatric wards and ND is a frequent healthcare-associated infection in hospitalised infants.
The use of pacifiers during hospital stay does not seem to affect the incidence of ND in infants in a high diarrhoea burden setting. Breast feeding reduces the incidence of ND in infants in a high diarrhoea burden setting.
Strengths and limitations of this study
The study did not assess microbial aetiology of ND and, due to limited isolation facilities, infants admitted with community-acquired diarrhoea were not routinely segregated in this study setting.
To our knowledge, this is the first report of a hospital-based prospective cohort designed to investigate the association of pacifier use and the risk of ND in infants.