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[Healthcare-Associated Infections in Pediatric Patients: A Decade of Experience in an Intensive Care Unit]
Cátia Martins1, Daniela Lima2, Mariana Cortez Ferreira3
1*Co-primeira autora; Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico. Unidade Local de Saúde de Coimbra. Coimbra. Portugal.
Insights
Healthcare-associated infections (HAIs) affect 6.3% of pediatric ICU patients in Portugal, with pneumonia being most common. Antibiotic resistance is increasing, highlighting the need for effective control strategies.
Area of Science:
- Pediatric Intensive Care Medicine
- Infectious Diseases
- Epidemiology
Context:
- Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in pediatric intensive care units (PICUs).
- Limited data exist on HAIs in the Portuguese pediatric population.
- This study addresses this gap by investigating HAI prevalence, pathogens, and antibiotic resistance in a Portuguese PICU.
Purpose:
- To estimate the prevalence of healthcare-associated infections in a Portuguese pediatric intensive care unit.
- To identify the most frequent microorganisms causing HAIs.
- To determine the antibiotic resistance profiles of these pathogens.
Summary:
- A retrospective cohort study identified 248 HAIs (6.3% prevalence) in a Portuguese PICU (2014-2023), predominantly in infants.
- Pneumonia (45.2%) and bacteremia (14.5%) were most common, caused mainly by Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae).
- Antibiotic resistance, including ESBL-producing bacteria, MRSA, and ERC, increased from 2019-2023. Sepsis occurred in 29.8% of cases, with an 11.7% mortality rate (4.0% directly attributed to HAIs).
Impact:
- Findings underscore the rising threat of antibiotic resistance in pediatric critical care.
- Identifies key pathogens and risk factors (endotracheal tubes, prolonged ventilation) for pneumonia.
- Emphasizes the urgent need for effective strategies to prevent and control resistant bacteria to improve patient safety and public health.
Introduction:
Healthcare-associated infections are an important cause of morbidity and mortality in the pediatric population and a growing problem in intensive care services. However, limited data are available on these infections in the Portuguese pediatric population. This study aimed to estimate its prevalence rate in a Portuguese pediatric intensive care unit, identifying the most frequent microorganisms and their antibiotic resistance profiles.
Methods:
A retrospective cohort study was conducted, including patients admitted to a pediatric intensive care unit between January 1, 2014 and December 31, 2023, who were diagnosed with healthcare-associated infections during hospitalization.
Results:
A total of 248 nosocomial infections were identified, corresponding to a prevalence rate of 6.3%, mostly in infants. Pneumonia (45.2%) and bacteremia (14.5%) were the most frequent infections. Gram-negative bacteria, specifically Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, were the most common pathogens. Over the last five years (2019 - 2023), there was a global increase in antibiotic resistance. The prevalence of infections with ESBL-producing bacteria, MRSA and ERC was 8.5%, 1.6%, and 0.4%, respectively, higher in the period from 2019 to 2023. Among 97 screening tests, 45 colonizations were identified in 41 patients: 40 with ESBL and 5 with ERC, with no MRSA colonizations detected. Sepsis occurred in 29.8% of cases, and the mortality rate was 11.7%, with 4.0% directly attributed to healthcare-associated infections. Risk factors for pneumonia included exposure to endotracheal tubes and prolonged invasive ventilation (OR = 2.5; 95% CI, 1.1 to 5.9, p = 0.03; and OR = 1.9; 95% CI, 1.1 to 3.4, p = 0.011; respectively).
Conclusion:
Implementing effective strategies to prevent and control resistant bacteria is essential to safeguard current therapies, enhance patient safety, and protect public health.
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