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BMJ Open 2:e000427 doi:10.1136/bmjopen-2011-000427
  • Paediatrics
    • Research

Do pacifiers increase the risk of nosocomial diarrhoea? A cohort study

  1. Luciane Soares de Lima1
  1. 1Universidade Federal de Pernambuco, Recife, Brazil
  2. 2Instituto de Medicina Integral Prof. Fernando Figueira, Faculdade Pernambucana de Saúde, Recife, Brazil
  3. 3Instituto de Medicina Integral Prof. Fernando Figueira, Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
  1. Correspondence to Dr Maria Júlia Gonçalves de Mello; mjuliagmello{at}gmail.com
  • Received 26 October 2011
  • Accepted 27 February 2012
  • Published 16 April 2012

Abstract

Design Prospective cohort study.

Setting Teaching paediatric hospital—Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast Brazil.

Participants 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.

Results 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.

Conclusions 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.

Footnotes

  • To cite: Sette GCS, Mello MJG, Correia JB, et al. Do pacifiers increase the risk of nosocomial diarrhoea? A cohort study. BMJ Open 2012;2:e000427. doi:10.1136/bmjopen-2011-000427

  • Contributors The listed authors have made the following contributions to this article: GCSS: substantial contributions to conception, design, acquisition, analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published. MJGdM: substantial contributions to conception, design, analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published. JBC: substantial contributions to conception, design, analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published. ISS: substantial contributions to acquisition and analysis of data; revising the article critically for important intellectual content; final approval of the version to be published. GAPdS: substantial contributions to conception, design, analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published. LSdL: substantial contributions to conception, design, analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published.

  • Funding This study was funded by the Instituto de Medicina Integral Prof. Fernando Figueira—IMIP, through its institutional Fund for Education and Research.

  • Competing interests None.

  • Ethics approval Ethic approval was provided by Comite de Etica em Pesquisa em Seres Humanos do Instituto de Medicina Integral Prof. Fernando Figueira.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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