High rates of nosocomial infections and antimicrobial resistance in a Moroccan pediatric intensive care unit: A cause for alarm

•There is a high nosocomial infection rate (44.7%) in the pediatric intensive care unit; bacteremia is the most common.•Gram-negative bacteria dominate infections.•Long stays, devices, and antibiotics raise infection risk.•Extended intensive care unit stay linked to nosocomial infections and is associated with high mortality.•Effective strategies are needed to improve infection control and antibiotic use. This study aimed to determine the epidemiology of nosocomial infections (NIs) in a pediatric intensive care unit and define the risk factors associated with NIs. We performed a prospective descriptive and analytical monocentric study on the incidence of NIs in the pediatric intensive care unit between July 2021 and May 2022. Children with NIs (cases) were compared with matched controls without NIs. We analyzed 396 patients; 102 had NIs. The global incidence of NIs is 44.7% (incidence density of 10.6 per 1000 days of hospitalization). The incidence densities of blood stream infection, pneumonia associated with mechanical ventilation, and urinary tract infection were 10 per 1000 days of central venous catheter use, 7.2 per 1000 of mechanical ventilation use, and 11.1 per 1000 days urinary catheter use. The overall microbiological profile of NIs is dominated by gram-negative bacilli in 78%, followed by gram-positive cocci in 13%. The most common agents in sepsis were Klebsiella pneumoniae. In pneumonias, Acinetobacter Baumanii was the most common cause, and, in urinary tract infection, the most frequent agents were gram-negative bacteria, especially Escherichia coli (33.3%). The presence of NIs was associated with a long period of hospitalization, use of invasive devices (central venous catheter, mechanical ventilation, and bladder catheters), and use of antibiotics. The incidence of NIs acquired in this unit was high and was associated with extrinsic and intrinsic factors.