Article English OPEN
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.
  • References (33)
    33 references, page 1 of 4

    1. Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-careassociated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228-241.

    2. Esteban E, Ferrer R, Urrea M, et al. The impact of a quality improvement intervention to reduce nosocomial infections in a PICU. Pediatr Crit Care Med 2013;14:525-532.

    3. Martin-Loeches I, Diaz E, Valles J. Risks for multidrug-resistant pathogens in the ICU. Curr Opin Crit Care 2014;20:516-524.

    4. Mathot F, Duke T, Daley AJ, Butcher T. Bacteremia and pneumonia in a tertiary PICU: an 11-year study. Pediatr Crit Care Med 2015;16:104-113.

    5. IDSA. The 10 x '20 Initiative: pursuing a global commitment to develop 10 new antibacterial drugs by 2020. Clin Infect Dis 2010;50:1081-1083.

    6. McGrath EJ, Asmar BI. Nosocomial infections and multidrug-resistant bacterial organisms in the pediatric intensive care unit. Indian J Pediatr 2011;78:176-184.

    7. Mitt P, Metsvaht T, Adamson V, et al. Five-year prospective surveillance of nosocomial bloodstream infections in an Estonian paediatric intensive care unit. J Hosp Infect 2014;86:95-99.

    8. Burnham JP, Lane MA, Kollef MH. Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy. Crit Care Med 2015;43:1580-1586.

    9. Lambert ML, Suetens C, Savey A, et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect Dis 2011;11:30-38.

    10. Lye DC, Earnest A, Ling ML, et al. The impact of multidrug resistance in healthcareassociated and nosocomial Gram-negative bacteraemia on mortality and length of stay: cohort study. Clin Microbiol Infect 2012;18:502-508.

  • Metrics
    No metrics available
Share - Bookmark