HEALTHCARE-ASSOCIATED INFECTIONS IN PAEDIATRIC AND NEONATAL INTENSIVE CARE UNITS: IMPACT OF UNDERLYING RISK FACTORS AND ANTIMICROBIAL RESISTANCE ON 30-DAY CASE-FATALITY

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Sharland, M ; Folgori, L ; Bernaschi, P ; Piga, S ; Carletti, M ; Pirrone Cunha, F ; Lara, PHR ; Cafeiro de Castro Peixoto, N ; Gomes Alves Guimares, B ; da Silva, ARA ; Atti, MCD (2016)
  • Publisher: Cambridge University Press

Objectives.\ud Our aims were (i) to describe trends in the epidemiology of Healthcare-associated Infections (HAIs) in paediatric/neonatal ICUs and (ii) to evaluate risk factors and impact of Multidrug-Resistance (MDR) in children admitted to ICUs.\ud \ud Design.\ud Multicentre, retrospective, cohort study \ud with a nested case-control study conducted between January 2010 and December 2014.\ud \ud Setting. \ud Three tertiary-care paediatric hospitals in Italy and Brazil with a total of 97 ICU beds. \ud \ud Patients.\ud Inclusion criteria were (i) admission to ICU during the study period (ii) age at onset <18 years and (iii) microbiologically-confirmed HAI.\ud \ud Results.\ud 538 HAIs in 454 children were included. 93.3% of patients had comorbidities. Bloodstream infections (BSIs) were the leading pattern (45.4%). The cumulative incidence of HAI was 3.6/100 ICU-admission and the crude 30-day fatality rate was 5.7/1,000-admission. The most frequently\ud isolated pathogens were Enterobacteriaceae, followed by \ud Pseudomonas aeruginosa and Staphylococcus aureus.44% of isolates were MDR. Two multivariate logistic regressions were performed. Factors independently associated with an MDR\ud -HAI were Country, previous antibiotics, transplantation, major surgery, and colonisation by an MDR strain. Factors independently associated with 30-day case-fatality were Country, previous transplantation, fungal infection, BSI, LRTI, and infection caused by MDR strains. \ud \ud Conclusions.\ud Infection control and prevention should be a primary focus to limit the spread of MDR strains and improve the outcome of hospitalised patients. Targeted surveillance programmes \ud collecting neonatal and paediatric HAI/BSI data and outcomes would allow global benchmarking between centres. The next step is to identify simple methods to monitor key HAIs and integrate these into affordable intervention programmes.
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