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Factors Associated with Time to Acquisition of Bloodstream Infection in a Pediatric Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Maria Júlia Gonçalves de Mello ,
Maria de Fátima Pessoa Militão de Albuquerque ,
Ricardo Arraes de Alencar Ximenes ,
Heloísa Ramos Lacerda ,
Eduardo Jaime Seara Ferraz ,
Rita Byington  and
Maria Tereza Serrano Barbosa
Maria Júlia Gonçalves de Mello*
Affiliation:
Instituto de Medicina Integral Professor Fernando Figueira, Rio de Janeiro, Brazil
Maria de Fátima Pessoa Militão de Albuquerque
Affiliation:
Centra de Pesquisas Aggeu Magalhães, Rio de Janeiro, Brazil
Ricardo Arraes de Alencar Ximenes
Affiliation:
Universidade Federal de Pernambuco, Recife, Brazil
Heloísa Ramos Lacerda
Affiliation:
Universidade Federal de Pernambuco, Recife, Brazil
Eduardo Jaime Seara Ferraz
Affiliation:
Centra de Pesquisas Aggeu Magalhães, Rio de Janeiro, Brazil
Rita Byington
Affiliation:
Instituto Nacional do Câncer, Rio de Janeiro, Brazil
Maria Tereza Serrano Barbosa
Affiliation:
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
*
Rua Paulino Gomes de Souza, 136 Apartamento 1001, Aflitos, Recife, PE, Brazil52 050-250 (juliagmello@imip.org.br)
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Extract

Objective.

To evaluate the risk factors that influence time to acquisition of a laboratory-confirmed bloodstream infection (LCBI).

Design.

Prospective cohort study with an 18-month follow-up.

Setting.

A 16-bed medical and/or surgical pediatric intensive care unit that cares for patients of the Brazilian Public Health System exclusively.

Patients.

We included children from 0 to 18 years old who were represented by 875 consecutive admissions to the pediatric intensive care unit from January 1, 2005, through June 30, 2006. The children from all but 5 (0.6%) of the admissions were followed up until discharge or death. The majority (506 [58.2%]) were hospitalized for surgical pathology, and 254 (29.2%) underwent heart surgery.

Methods.

We used a standardized questionnaire and data collection from daily charts. Information on risk factors was collected before the onset of first LCBI. Survival analysis was performed using the Kaplan-Meier method. The effect of the variables on the risk of LCBI each day was estimated through a Cox model fitting.

Results.

Fifty-seven children (6.6%) developed an LCBI, 54 (94.7%) of whom made use of a central venous catheter. LCBI incidence was 11.27 episodes/1,000 patient-days and 17.92 episodes/1,000 patient-days when associated with a central venous catheter. Factors associated with time to the first LCBI in the Cox model were age less than 2 years (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.02–3.89), malnutrition (HR, 1.74; 95% CI, 1.01–3.00), use of a central venous catheter (HR, 4.36; 95% CI, 1.30–14.64), use of antibiotics before admission (HR, 0.58; 95% CI, 0.33–0.98), and use of transfused blood products (HR, 0.40; 95% CI, 0.22–0.74).

Conclusion.

Factors associated with time to acquisition of LCBI were age less than 2 years, weight-for-age z score less than −2, and the use of a central venous catheter. Therefore, intensification of LCBI prevention efforts in patients with these characteristics is fundamental.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 249 - 255
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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