Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018

Area of Science:

• Infection Control and Epidemiology
• Pediatric Critical Care Medicine
• Healthcare-Associated Infections

Background:

• Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are significant causes of morbidity, mortality, and increased healthcare costs in pediatric patients.
• Effective prevention strategies are crucial for reducing the burden of these infections in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs).

Purpose of the Study:

• To analyze trends in CLABSI and CAUTI rates from 2013 to 2018 within US NICUs and PICUs.
• To evaluate changes in device utilization for central lines and urinary catheters during the study period.

Main Methods:

• A time series analysis was conducted using prospective surveillance data from 176 US hospitals.
• Data included patients aged 18 years or younger admitted to NICUs or PICUs.
• Generalized estimating equations were used to assess yearly changes in infection rates and device utilization.

Main Results:

• CLABSI rates (device-associated and population-based) and central catheter utilization remained stable in both NICUs and PICUs.
• Device-associated CAUTI rates in PICUs showed no significant change.
• Population-based CAUTI rates in PICUs significantly decreased by 8% annually, with a 6% annual decrease in urinary catheter utilization.

Conclusions:

• Current CLABSI prevention strategies have plateaued, necessitating the development of novel approaches for critically ill neonates and children.
• The observed decrease in population-based CAUTI rates suggests improved and more judicious use of indwelling urinary catheters in PICUs.