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[Epidemiology of nosocomial infections in pediatrics]
1Service microbiologie, hôpital Saint-Vincent de Paul, 82, avenue Saint-Vincent de Paul, 75674 Paris, France. j.raymond@svp.ap-hop-paris.fr
Insights
Nosocomial infections (NI) in children vary by age and unit, with gastrointestinal issues and bacteremia being common. Limiting antimicrobial therapy is crucial for both pediatric and adult patients.
Area of Science:
- Pediatric Infectious Diseases
- Hospital-Acquired Infections
- Antimicrobial Stewardship
Context:
- Nosocomial infections (NI) present a significant challenge in pediatric healthcare settings.
- Incidence rates of NI in children range from 2.3% to 12.6%, with notable variations based on age and unit type.
Purpose:
- To analyze the epidemiology of nosocomial infections in pediatric populations.
- To identify common sites of infection, causative pathogens, and antimicrobial resistance patterns in children.
- To compare pediatric NI data with adult populations and inform clinical practice.
Summary:
- Pediatric NI incidence varies significantly, with higher rates in younger children and intensive care units.
- Gastrointestinal infections and bacteremia are the most frequent NI sites in children, unlike adults where urinary tract and respiratory infections dominate.
- Key pathogens include viruses, Gram-positive cocci (e.g., coagulase-negative staphylococci), and Gram-negative bacilli (e.g., Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae).
- While methicillin-resistant Staphylococcus aureus is less common in children, Candida infections are an emerging concern, highlighting the need for judicious antimicrobial use.
Impact:
- Findings underscore the importance of tailored infection control strategies in pediatric units.
- The study emphasizes the necessity of limiting antimicrobial therapy in children to combat resistance.
- Highlights emerging trends like Candida infections in pediatrics, requiring further investigation and management adjustments.
Abstract:
The overall incidence of nosocomial infections (NI) in pediatrics ranges between 2.3% to 12.6%. They have great variations according to age (7-12% under 1 year of age vs 1.5-4% after ten years of age), and the nature of the unit (3-26% in intensive care units vs 1-4% in general pediatrics). The main sites of infection are in children gastrointestinal infections (10-35% of NI) and bacteremia (10-23% of NI) whereas in adults urinary tract infections (31.7 to 35%) and respiratory infections (19 to 25%) are the most frequent. Viruses represent 22-27% of the isolated pathogens, and Gram positive cocci 31-50% (half of them are coagulase negative staphylococci). The most frequent Gram negative bacilli are Pseudomonas aeruginosa (9-15%), E. coli (6-16%) and Klebsiella pneumoniae (3-5%). Candida represent 3% of isolated pathogens in NI. The proportion of methicilline-resistant Staphylococcus aureus is lower in children than in adults. The prevalence of methicillin resistance of CNS is however close to that observed in adults, as is the multiresistance of Gram negative bacilli (Klebsiella). Candida infections seem an emerging problem in paediatrics. These results underline the necessity to limit the antimicrobial therapy in children as in adults.