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31 May 2007

Nosocomial bloodstream infections in a pediatric intensive care unit: 3-year survey

Galia Grisaru-Soen, Yaser Sweed, Liat Lerner-Geva, Galit Hirsh-Yechezkel, Valentina Boyko, Amir Vardi, Nathan Keller, Zohar Barzilay, Gideon Paret

Med Sci Monit 2007; 13(6): CR251-257 :: ID: 484116

Abstract

Background: Bloodstream infections (BSI) represent a major cause of hospital-acquired infections in pediatric intensive care unit (PICU) patients. This study was designed to determine the prevalence, risk factors and outcomes of these infections in one local facility.
Material/Methods: All patients admitted to one PICU between January 1, 2000 - December 31, 2002 and subsequently developed a nosocomial bloodstream infection (NBSI) were consecutively recruited. The study was a retrospective study. Data retrieved from medical records included demographic information, extrinsic (invasive devices) and intrinsic risk factors, specific pathogens, therapeutic interventions and outcome.
Results: There were 95 episodes of NBSIs in 59 patients (63/1711 PICU admissions, yielding an incidence of 56/1000). The crude mortality rate (CMR) in children with NBSIs was 52%, compared with 6% for all other children admitted to the PICU. A higher CMR was associated with hemato-oncology illness, prolonged length of hospitalization (>1 month) mechanical ventilation, dialysis and severity of illness. Most of the patients (95%) had central intravascular devices, and 73% of the episodes were catheter-related infections. The most frequent pathogens were coagulase-negative staphylococci (24%), Klebsiella pneumonia (16%), Candida spp. (15%), Pseudomonas aeruginosa (7%) and Staphylococcus aureus (6%). Thirty-three percent of the Staphylococcus aureus were methicillin resistant (MRSA) and 30% of the Klebsiella pneumonia were extended - spectrum beta-lactamase - producing (ESBL) strains.
Conclusions: The overall incidence of NBSIs was 56 episodes per 1000 admissions. The major risk factors were hemato-oncology illness, prolonged length of hospitalization, mechanical ventilation, dialysis and severity of illness. Children with NBSI had a poor outcome when compared with children without NBSI.

Keywords: Bacteremia - pathology, Multivariate Analysis, Intensive Care Units, Pediatric, Hospitalization, Health Care Surveys, Fungi - isolation & purification, Cross Infection - mortality, Child, Bacteria - isolation & purification, Bacteria - isolation & purification, Multivariate Analysis, Intensive Care Units, Pediatric, Hospitalization, Health Care Surveys, Fungi - isolation & purification, Cross Infection - mortality, Child, Bacteremia - pathology

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Medical Science Monitor eISSN: 1643-3750