A Systematic Review of Pediatric-Specific Risk Factors for Nosocomial Infections in Pediatric Intensive Care Units,...

Children admitted to the pediatric intensive care unit (PICU) are at markedly high risk of nosocomial infections (NIs, also termed hospital-acquired infections [HAIs]), which correlate with elevated mortality, extended hospital stays, and amplified healthcare burdens. Children exhibit distinct immunological and physiological traits compared with adult patients, highlighting an urgent need for pediatric-specific evidence to guide infection prevention. The latest existing systematic review on this topic was published in 2009, failing to cover emerging multidrug-resistant infections (MDRIs) and modern pediatric critical care management practices. This systematic review aimed to synthesize two decades of evidence on pediatric-specific risk factors for PICU-onset nosocomial infections, encompassing all-site NIs, ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CA-UTIs), and bloodstream infections (BSIs)-with central line-associated bloodstream infections (CLABSIs) as the predominant subtype-to deliver updated evidence supporting targeted infection control strategies.

We performed a comprehensive electronic literature search across six databases: PubMed, Embase, Web of Science, CNKI, VIP, and Wanfang, covering publications released between January 2005 and December 2024. Two independent reviewers completed literature screening, data extraction, and methodological quality assessment in accordance with pre-established inclusion and exclusion criteria. All eligible observational studies investigating risk factors for NIs in PICU populations were included for qualitative synthesis.

Overall, 24 observational studies involving 74,960 hospitalized children (2,863 of whom developed NIs) were incorporated into this review. Consistent risk factors for all-site PICU NIs comprised younger age, prolonged PICU length of stay, invasive procedures, parenteral nutrition, glucocorticoid administration, and high admission illness severity (quantified via the PRISM III or PCIS scoring systems). For VAP, independent risk factors were prolonged mechanical ventilation duration, reintubation, and pre-existing lung disease or baseline pneumonia before ventilation initiation. Indwelling urinary catheters constituted a core risk factor for catheter-associated UTIs. Risk factors predictive of MDRIs included administration of two or more antimicrobial agents, coma, parenteral nutrition, and extended mechanical ventilation.

PICU-onset NIs stem from multiple modifiable risk exposures: invasive medical devices, extended intensive care hospitalization, parenteral nutrition, glucocorticoid therapy, and inappropriate overprescription of antimicrobials. Implementation of PICU-tailored infection control bundles and stratified surveillance for high-risk children is critical to reduce NI incidence. Large, standardized multicenter prospective cohorts are warranted to harmonize infection diagnostic criteria and develop optimized pediatric-specific guidelines for NI prevention.

The review protocol was prospectively registered on PROSPERO (Registration No. CRD42025635030).