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Healthcare-Associated Infections in Pediatric and Neonatal Intensive Care Units: Impact of Underlying Risk Factors and Antimicrobial Resistance on 30-Day Case-Fatality in Italy and Brazil

  • Laura Folgori (a1) (a2), Paola Bernaschi (a3), Simone Piga (a4), Michaela Carletti (a3), Filippe Pirrone Cunha (a5), Paulo Henrique Rodriguez Lara (a5), Nicholas Cafieiro de Castro Peixoto (a5), Bárbara Gomes Alves Guimarães (a5), Mike Sharland (a2), André Ricardo Araujo da Silva (a5) (a6) and Marta Ciofi degli Atti (a4)...
Abstract
OBJECTIVES

To describe trends in the epidemiology of healthcare-associated Infections (HAIs) in pediatric/neonatal intensive care units (ICUs) and to evaluate risk factors and impact of multidrug resistance in children admitted to ICUs.

DESIGN

Multicenter, retrospective, cohort study with a nested case-control study conducted from January 1, 2010, through December 31, 2014.

SETTING

Three tertiary care pediatric hospitals in Italy and Brazil with a total of 103 ICU beds.

PATIENTS

Inclusion criteria were admission to ICU during the study period, age at onset less than 18 years, and microbiologically confirmed HAI.

RESULTS

A total of 538 HAIs in 454 children were included; 93.3% of patients had comorbidities. Bloodstream infections were the leading pattern (45.4%). The cumulative incidence of HAI was 3.6/100 ICU admissions and the crude 30-day fatality rate was 5.7/1,000 admissions. The most frequently isolated pathogens were Enterobacteriaceae, followed by Pseudomonas aeruginosa and Staphylococcus aureus. Forty-four percent of isolates were multidrug-resistant (MDR). Two multivariate logistic regressions were performed. Factors independently associated with an MDR-HAI were country, previous antibiotics, transplantation, major surgery, and colonization by an MDR strain. Factors independently associated with 30-day case fatality were country, previous transplantation, fungal infection, bloodstream infection, lower respiratory tract infection, and infection caused by MDR strains.

CONCLUSIONS

Infection control and prevention can limit the spread of MDR strains and improve outcomes. Targeted surveillance programs collecting neonatal and pediatric HAI/bloodstream infection data and outcomes would allow global benchmarking. The next step is to identify methods to monitor key HAIs and integrate these into affordable intervention programs.

Infect Control Hosp Epidemiol 2016;1–8

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Copyright
Corresponding author
Address correspondence to Laura Folgori, MD, St George’s University of London, Cranmer Terrace, SW17 0RE, London, UK (laura.folgori@gmail.com).
Footnotes
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A.R.A.d.S. and M.C.d.A. contributed equally to this article.

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References
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1. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228241.
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;14:525532.
3. Martin-Loeches, I, Diaz, E, Valles, J. Risks for multidrug-resistant pathogens in the ICU. Curr Opin Crit Care 2014;20:516524.
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;16:104113.
5. Infectious Diseases Society of America (IDSA). The 10 x '20 Initiative: pursuing a global commitment to develop 10 new antibacterial drugs by 2020. Clin Infect Dis 2010;50:10811083.
6. McGrath, EJ, Asmar, BI. Nosocomial infections and multidrug-resistant bacterial organisms in the pediatric intensive care unit. Indian J Pediatr 2011;78:176184.
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;86:9599.
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;43:15801586.
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;11:3038.
10. Lye, DC, Earnest, A, Ling, ML, et al. The impact of multidrug resistance in healthcare-associated and nosocomial gram-negative bacteraemia on mortality and length of stay: cohort study. Clin Microbiol Infect 2012;18:502508.
11. Patel, SJ, Oliveira, AP, Zhou, JJ, et al. Risk factors and outcomes of infections caused by extremely drug-resistant gram-negative bacilli in patients hospitalized in intensive care units. Am J Infect Control 2014;42:626631.
12. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
13. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268281.
14. Monsen, T, Karlsson, C, Wistrom, J. Spread of clones of multidrug-resistant, coagulase-negative staphylococci within a university hospital. Infect Control Hosp Epidemiol 2005;26:7680.
15. Banerjee, SN, Grohskopf, LA, Sinkowitz-Cochran, RL, Jarvis, WR. Incidence of pediatric and neonatal intensive care unit-acquired infections. Infect Control Hosp Epidemiol 2006;27:561570.
16. Grohskopf, LA, Sinkowitz-Cochran, RL, Garrett, DO, et al. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 2002;140:432438.
17. Rutledge-Taylor, K, Matlow, A, Gravel, D, et al. A point prevalence survey of health care-associated infections in Canadian pediatric inpatients. Am J Infect Control 2012;40:491496.
18. Simon, A, Bindl, L, Kramer, MH. Surveillance of nosocomial infections: prospective study in a pediatric intensive care unit. Background, patients and methods [article in German]. Klin Padiatr 2000;212:29.
19. Murni, IK, Duke, T, Kinney, S, Daley, AJ, Soenarto, Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child 2015;100:454459.
20. Muhlemann, K, Franzini, C, Aebi, C, et al. Prevalence of nosocomial infections in Swiss children’s hospitals. Infect Control Hosp Epidemiol 2004;25:765771.
21. Logan, LK, Braykov, NP, Weinstein, RA, Laxminarayan, R; CDC Epicenters Prevention Program. Extended-spectrum beta-lactamase-producing and third-generation cephalosporin-resistant Enterobacteriaceae in children: trends in the United States, 1999-2011. J Pediatric Infect Dis Soc 2014;3:320328.
22. Lukac, PJ, Bonomo, RA, Logan, LK. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: old foe, emerging threat. Clin Infect Dis 2015;60:13891397.
23. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:6067.
24. Chiotos, K, Han, JH, Tamma, PD. Carbapenem-resistant Enterobacteriaceae infections in children. Curr Infect Dis Rep 2016;18:2.
25. Fernandez-Reyes, M, Vicente, D, Gomariz, M, et al. High rate of fecal carriage of extended-spectrum-beta-lactamase-producing Escherichia coli in healthy children in Gipuzkoa, northern Spain. Antimicrob Agents Chemother 2014;58:18221824.
26. Malacarne, P, Boccalatte, D, Acquarolo, A, et al. Epidemiology of nosocomial infection in 125 Italian intensive care units. Minerva Anestesiol 2010;76:1323.
27. Shime, N, Kawasaki, T, Saito, O, et al. Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan. Intensive Care Med 2012;38:11911197.
28. Green, N, Johnson, AP, Henderson, KL, et al. Quantifying the burden of hospital-acquired bloodstream infection in children in England by estimating excess length of hospital stay and mortality using a multistate analysis of linked, routinely collected data. J Pediatric Infect Dis Soc 2015;4:305312.
29. Diez Roux, AV, Aiello, AE. Multilevel analysis of infectious diseases. J Infect Dis 2005;191:S25S33.
30. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162e193.
31. Zachariah, P, Reagan, J, Furuya, EY, et al. The association of state legal mandates for data submission of central line-associated bloodstream infections in neonatal intensive care units with process and outcome measures. Infect Control Hosp Epidemiol 2014;35:11331139.
32. Global Antimicrobial Resistance, Prescribing, and Efficacy among Neonates and Children (GARPEC). GARPEC website. http://garpec.org/. Accessed January 24, 2016.
33. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. 2011–2012. Stockholm: ECDC, 2013. http://ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf. Accessed January 24, 2016.
34. International Nosocomial Infection Control Consortium (INICC). INICC website. http://www.inicc.org/. Accessed March 3, 2016.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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