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Bacteremia and pneumonia in a tertiary PICU: an 11-year study
Femke Mathot1, Trevor Duke, Andrew J Daley
11Erasmus University Medical School, Rotterdam, The Netherlands. 2Paediatric Intensive Care Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia. 3Centre for International Child Health, University of Melbourne and Murdoch Childrens Research Institute, Parkville, VIC, Australia. 4Department of Microbiology and Infection Prevention and Control, Royal Children's Hospital, Melbourne, VIC, Australia.
Insights
Multidrug-resistant infections in pediatric intensive care units (PICUs) pose significant threats, leading to high death rates. Interventions in antibiotic stewardship and infection control successfully reduced these serious bacterial infections from 2011 onwards.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Critical Care Medicine
Background:
- Serious bacterial infections, including bloodstream infections (bacteremia) and pneumonia, are significant concerns in pediatric intensive care units (PICUs).
- Understanding the trends in pathogens, antibiotic resistance, and patient outcomes is crucial for effective management.
Purpose of the Study:
- To analyze the trends in etiology, antibiotic resistance, and patient outcomes of bacteremia and pneumonia in a PICU over an 11-year period.
- To evaluate the impact of interventions aimed at reducing multidrug-resistant and other serious bacterial infections.
Main Methods:
- A retrospective cohort study was conducted using data from January 2002 to December 2012 in a PICU.
- Bacterial and fungal pathogens from blood cultures and bronchoalveolar lavage fluid were identified.
- Trends in infection etiology, antibiotic resistance, and case fatality rates were analyzed.
Main Results:
- Serious bacterial or fungal infections occurred in 8.9% of patients, with 1.2% experiencing multidrug-resistant infections.
- Serious infections were associated with a case fatality rate of 17.5%, significantly higher than the overall PICU rate of 6.0%.
- Multidrug-resistant infections and persistent/recurrent infections had substantially higher case fatality rates (25.6% and 43.1%, respectively).
Conclusions:
- Multidrug-resistant and persistent/recurrent bacterial sepsis are major threats in pediatric intensive care, associated with high mortality.
- The study demonstrates a successful model for monitoring serious infections and assessing the impact of infection control interventions in the PICU.
Objectives:
To describe trends in aetiology and resistance patterns and patient outcomes of bacteraemia and pneumonia in a PICU over an 11-year period. We also describe interventions aimed at reducing multi-resistant infections and other serious bacterial infections in the PICU.
Design And Setting:
This cohort study involved data collected between January 2002 and December 2012 in the PICU of the Royal Children's Hospital in Melbourne, Australia. We documented all bacterial and fungal pathogens isolated from culture of blood or bronchial alveolar lavage fluid. Trends in aetiology and antibiotic resistance patterns were evaluated, as well as the case fatality rates of population-subgroups.
Patients, Measurement And Main Results:
Overall, 881 patients (8.9%) had 1,480 serious bacterial or fungal infections and 1.2% of the PICU population suffered a multidrug-resistant infection. Twenty-six percent of 597 total deaths in the PICU during that time period were associated with a serious bacterial infection of the blood or lungs. Children in PICU with a serious infection in blood or lungs had a case fatality rate of 17.5% (95% CI, 15.0-20.2), compared with children overall in the PICU with a case fatality rate of 6.0% (95% CI, 5.5-6.5). The case fatality rate among children with multidrug-resistant sepsis was 25.6% (95% CI, 18.1-34.4) and among children with a persistent or recurrent infection in blood or lungs was 43.1% (95% CI, 30.8-56.0). Cases of multidrug-resistant bacteremia and bronchial alveolar lavage-proven pneumonia increased from 2002 to 2010 and significantly decreased from 2011, coinciding with improvements in antibiotic stewardship and infection control.
Conclusions:
Multiresistant bacterial sepsis and persistent or recurrent sepsis are major threats in pediatric intensive care and are associated with disproportionally high death rates. Our study describes a model for monitoring these serious infections and the effects of infection control interventions in the PICU.
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