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Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis
Mari Takashima1,2, Areum Hyun1, Grace Xu1,3
1The University of Queensland, Queensland, Australia.
Insights
This study analyzed infection rates for pediatric patients with invasive devices. Central venous access device bloodstream infections (CVAD-BSI) and ventilator-associated pneumonia were common, highlighting the need for standardized infection control guidelines for all devices.
Area of Science:
- Pediatric Healthcare Epidemiology
- Infectious Diseases
- Medical Device Infections
Background:
- Indwelling invasive devices are crucial for pediatric healthcare but pose infection risks.
- Estimating infection proportions and rates associated with these devices is essential for patient safety.
Approach:
- A comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Web of Science.
- Meta-analysis of 116 cohort studies and trials published between 2011 and 2022, focusing on pediatric patients with invasive devices and subsequent infections.
- Data extraction followed MOOSE guidelines, focusing on device-specific local, organ, and bloodstream infections (BSIs).
Key Points:
- Central venous access device-associated bloodstream infections (CVAD-BSI) showed a pooled proportion of 8% (IR: 0.96 per 1000 device-days).
- Ventilator-associated pneumonia had a pooled proportion of 19% (IR: 14.08 per 1000 device-days).
- Reporting on local tissue and organ infections associated with invasive devices remains scarce.
Conclusions:
- While CVAD-BSIs and ventilator-associated pneumonia are well-documented, other device-related infections require more attention.
- Standardized infection control guidelines, similar to those for CVADs, should be developed and implemented for other invasive devices.
- Further research is needed to address the scarcity of data on local organ and tissue infections.
Context:
Indwelling invasive devices inserted into the body for extended are associated with infections.
Objective:
This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare.
Data Sources:
Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched.
Study Selection:
Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included.
Data Extraction:
Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used.
Main Outcomes And Measures:
Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported.
Results:
A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58).
Conclusions:
Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
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