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Published on: March 18, 2014
Infection in prolonged pediatric critical illness: A prospective four-year study based on knowledge of the carrier
R E Sarginson1, N Taylor, N Reilly
1Department of Pediatric Anaesthesia and Intensive Care, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, UK.
Insights
Most pediatric intensive care unit infections in children with prolonged stays originate from their own admission flora. Understanding infection sources is key to preventing hospital-acquired infections.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Epidemiology
Background:
- Healthcare-associated infections (HAIs) are a significant concern in pediatric intensive care units (PICUs).
- Prolonged PICU stays increase the risk of infection in critically ill children.
- Identifying the sources of infection is crucial for effective prevention strategies.
Purpose of the Study:
- To determine the rate, timing, and incidence density of infections in children with prolonged PICU stays.
- To analyze the origins of infections, distinguishing between endogenous and healthcare-acquired microorganisms.
- To assess the incidence of infections caused by resistant microorganisms.
Main Methods:
- Prospective, observational cohort study conducted over four years in a university hospital's 20-bed PICU.
- Included critically ill children requiring at least four days of intensive care.
- Surveillance cultures of throat and rectum were performed on admission and twice weekly to monitor microbial carrier status.
Main Results:
- The study analyzed 1,241 children and 1,443 admissions, totaling 18,203 patient days.
- Overall infection rate was 41.9%, with 33.0% bacterial/yeast and 14.5% viral infections.
- Two-thirds of infections were caused by microorganisms present in the patients' admission flora, predominantly within the first week.
Conclusions:
- A significant proportion of infections in prolonged PICU stays are endogenous, originating from the patient's own microbial flora.
- This highlights the importance of considering the patient's baseline microbial colonization in infection prevention protocols.
- Targeting endogenous microorganisms may be a critical strategy to reduce infection rates in this vulnerable population.
Objective:
This study was performed to determine the rate, timing, and incidence density of infections occurring in a subgroup of patients requiring a prolonged stay in a regional pediatric intensive care unit.
Design:
Prospective, observational cohort study over 4 yrs.
Setting:
This epidemiologic descriptive study was performed in a university hospital 20-bed pediatric intensive care unit.
Patients:
Critically ill children requiring > or = 4 days of intensive care.
Interventions:
The microbial carrier state of the children was monitored by surveillance cultures of throat and rectum, obtained on admission and twice weekly afterward.
Measurements And Main Results:
Data are presented on a total of 1,241 children, accounting for 1,443 admissions to the unit, corresponding to 18,203 patient days. The median pediatric index of mortality was 0.063 (interquartile range, 0.025-0.131), and the mortality rate in this subset of children was 9.6%. Five hundred twenty children had infections, an overall infection rate of 41.9% (520 of 1,241); 14.5% (180 of 1,241) of the children developed viral and 33.0% (410 of 1,241) developed bacterial/yeast infections. The incidence of bloodstream infection was 20.1 and lower airway infection 9.1 episodes per 1,000 patient days. We found that 13.3% of the children were infected with a bacterial/yeast microorganism acquired on the pediatric intensive care unit; 4.0% (50 of 1,241) of children developed infections due to resistant microorganisms. There were a total of 803 bacterial/yeast infectious episodes, of which 59.8% (480) were due to microorganisms imported in the patients' admission flora. These primary endogenous infections predominantly occurred within the first week of pediatric intensive care unit stay. The other 38.9% (312) were caused by microorganisms acquired on the pediatric intensive care unit. A total of 38 viral infections (24.5%) were acquired during pediatric intensive care unit stay.
Conclusions:
Two thirds of all infections diagnosed in children with prolonged illness on pediatric intensive care unit were due to microorganisms present in the patients' admission flora.
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