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Nosocomial Pediatric Bacteremia: The Role of Intravenous Set Contamination in Developing Countries

Abstract Objective: To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates. Design: Cultures of injection ports and infusate during 26 visits to 4 hospitals. Setting: Four public general pediatric hospitals in Mexico City with substandard care practices. Patients: Hospitalized pediatric patients receiving intravenous solutions. Results: Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%). Conclusion: These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.