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Six-Year Surveillance of Acquired Bloodstream Infection in a Pediatric Intensive Care Unit in Israel
Halima Dabaja-Younis1, Maha Alaiyan2, Ranaa Damouni Shalabi3
1Pediatric Infectious Diseases Unit; Infection Prevention and Control Unit, Rambam Health Care Campus, Haifa, Israel. and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Correspondence to: Dr. Halima Dabaja-Younis, Pediatric Infectious Disease Unit, Rambam Health Care Campus, Haifa 31096, Israel. h_dabaja@rambam.health.gov.il.
Insights
Bloodstream infections (BSI) in the pediatric intensive care unit (PICU) significantly increase mortality risk. Hemodynamic instability, high blood urea nitrogen, and low albumin levels are key predictors of poor outcomes in these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Clinical microbiology
Background:
- Bloodstream infections (BSI) are a significant concern in pediatric intensive care units (PICUs).
- Understanding the epidemiology and risk factors for BSI is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the profile of bloodstream infections (BSI) in a pediatric intensive care unit (PICU).
- To identify predictors of mortality associated with BSI in critically ill children.
Main Methods:
- Retrospective analysis of hospital records for pediatric patients (<18 years) with BSI between 2014 and 2019.
- Documented incidence, pathogens, and outcomes including mortality.
Main Results:
- 136 BSIs were identified in 114 patients, with Gram-negative rods being the most common pathogens (75%).
- BSI was associated with a significantly higher ICU mortality rate (21.9% vs. 3.1%, P<0.001).
- Hemodynamic instability, elevated blood urea nitrogen (BUN), and low albumin levels were identified as independent predictors of mortality.
Conclusions:
- Bloodstream infections in the PICU are linked to increased mortality.
- Early identification and management of risk factors like hemodynamic instability, BUN, and albumin levels are essential for improving survival rates in pediatric patients with BSI.
Objectives:
We studied profile of the bloodstream infections (BSI) in the pediatric intensive care unit (PICU) and identified predictors of mortality.
Methods:
The study collected data from hospital records for children younger than 18-years who developed BSI during their PICU stay between 2014 and 2019.
Results:
In 114 patients, 136 PICU-acquired BSIs with 152 pathogens were documented. The incidence of BSI was 47.12/1,000 PICU admissions and 7.95/1000 PICU hospital days. Gram-negative rods accounted for 75% of isolates, Gram-positive cocci accounted for 21.7% of isolates, and fungi accounted for 3.3% of isolated pathogens. ICU mortality was observed in 25 (21.9%) patients with a BSI compared to 94 (3.1%) patients without a BSI (P<0.001). Hemodynamic instability (P=0.014, OR 4.10, CI 1.33-12.66), higher blood urea nitrogen (BUN) (P=0.044), and lower albumin levels (P=0.029) were associated with increased risk of ICU mortality.
Conclusion:
BSI in the PICU is associated with increased mortality. Early identification and management of risk factors independently associated with poor clinical outcomes in these patients should be aimed to ensure improved survival.
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