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Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length
N Green1, A P Johnson2, K L Henderson2
1Public Health England, London, United Kingdom Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
Insights
Hospital-acquired bloodstream infections (HA-BSI) in children significantly increase hospital stays and in-hospital death risk. This study quantifies the impact of HA-BSI on pediatric patients, informing prevention strategies.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- Hospital-acquired bloodstream infections (HA-BSI) pose significant risks, including morbidity, mortality, and costs.
- Pediatric populations exhibit higher healthcare-associated infection rates than adults.
- This study quantifies excess mortality and length of stay in pediatric patients due to HA-BSI.
Purpose of the Study:
- To determine the impact of HA-BSI on pediatric inpatient mortality.
- To quantify the excess length of hospital stay associated with HA-BSI in children.
- To provide evidence for HA-BSI prevention and control programs in pediatric care.
Main Methods:
- Retrospective analysis of a national database of pediatric inpatients in England (January-March 2009).
- Inclusion of 333,605 patients, with 214 confirmed HA-BSI cases.
- Utilized time-dependent Cox regression and multistate models, adjusting for HA-BSI onset time and patient characteristics.
Main Results:
- Patients with HA-BSI had a 3.6 times higher hazard for in-hospital death compared to non-infected patients.
- Excess length of stay associated with HA-BSI was 1.6 days, varying by pathogen.
- The hazard for hospital discharge (alive or dead) was not significantly different (Hazard Ratio 0.9, 95% CI: 0.8-1.1).
Conclusions:
- Hospital-acquired bloodstream infections significantly increase mortality and length of stay in pediatric inpatients.
- Findings support the need for robust HA-BSI prevention and control measures in children's hospitals.
- The study provides crucial data on the health and economic burden of HA-BSI in pediatric populations.
Background:
Hospital-acquired bloodstream infection (HA-BSI) is associated with substantial morbidity, mortality, and healthcare costs in all patient populations. Young children have been shown to have a high rate of healthcare-associated infections compared with the adult population. We aimed to quantify the excess mortality and length of stay in pediatric patients from HA-BSI.
Methods:
We analyzed data collected retrospectively from a probabilistically linked national database of pediatric (aged 1 month-18 years) in-patients with a microbiologically confirmed HA-BSI in England between January and March 2009. A time-dependent Cox regression model was fit to determine the presence of any effect. Furthermore, a multistate model, adjusted for the time to onset of HA-BSI, was used to compare outcomes in patients with HA-BSI to those without HA-BSI. We further adjusted for patients' characteristics as recorded in hospital admission data.
Results:
The dataset comprised 333 605 patients, with 214 cases of HA-BSI. After adjustment for time to HA-BSI and comorbidities, the hazard for discharge (dead or alive) from hospital for patients with HA-BSI was 0.9 times (95% confidence interval [CI], .8-1.1) that of noninfected patients. Excess length of stay associated with all-cause HA-BSI was 1.6 days (95% CI, .2-3.0), although this duration varied by pathogen. Patients with HA-BSI had a 3.6 (95% CI, 1.3-10.4) times higher hazard for in-hospital death than noninfected patients.
Conclusions:
Hospital-acquired bloodstream infection increased the length of stay and mortality of pediatric inpatients. The results of this study provide an evidence base to judge the health and economic impact of programs to prevent and control HA-BSI in children.
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