Septicaemia in paediatric intensive-care patients at the Hospital for Sick Children, Great Ormond Street.

A review of nosocomial septicaemia in paediatric intensive care in a tertiary referral setting was undertaken for a 33-month period (1988-90). This involved six units: Cardiothoracic surgery; Neonatal surgery; general medical; Renal dialysis/transplant; Haematology/Oncology and Infectious disease/Immunology. The latter two units undertake bone marrow transplantation. During the study period, 10,719 admissions were made to these areas and 624 episodes of septicaemia were documented in 464 children. The frequency of septicaemia per 100 admissions ranged from 1.5 in the Renal Transplant Unit to 17.3 in the Haematology/Oncology unit. Over 60% of all septicaemic episodes occurred in children in the Haematology/Oncology and Cardiac Units. Gram-positive organisms were responsible for 66% of episodes, Gram-negative organisms for 17% and fungi for 3%. Polymicrobial episodes accounted for 13%. Coagulase-negative staphylococci were the most frequent isolates overall (43% of episodes in pure culture, and a further 6% in combination with other organisms). Staphylococcus aureus was associated with 10% of episodes, Enterobacteriaceae with 9% and Pseudomonas spp. 6% among which environmental pseudomonads predominated. Anaerobes and Haemophilus influenzae were each isolated in less than 1% of episodes.