Clinico-microbiological profile of health-care associated infections in a paediatric intensive care unit of tertiary care hospital

Abstract

Background: The study was undertaken to determine the total burden of health-care associated infections, microbiological profile and their impact on length of stay and mortality in a PICU of a tertiary care Hospital by prospective surveillance.Methods: All children ≥ one month and ≤ twelve years of age admitted in PICU for more than 48 hours from December 2009 to November 2010 were followed according to CDC/NHSN surveillance definitions of HCAI. Incidence rates, incidence densities and device utilization ratio were measured for different HCAI. Length of stay and mortality of HCAI were compared with non-HCAI patients. Antibiotic susceptibility pattern of isolated micro-organism was analyzed. Results: Out of total 618 patients admitted in PICU during study period 324 fulfilled study criteria. In those 324 patients 58 patients developed 68 episodes of HCAI. The CIR and IDs’of HCAI were17.9/100 patients and 22.14/1,000 patient-days, respectively. Of the 68 episodes of HCAI, there were 36 VAP, 17 BSI, 8 UTI, 2 pneumonia, 2 LRI-LUNG and 1each of SSI-MED, SST-Skin and GI-IAB. The most common microorganism isolated was Acinetobacter spp. followed by Pseudomonas spp. HCAI increased the average length of PICU stay (20 days versus 5 days, P<0.01) and Hospital stay (28 days versus 12 days, P<0.01). Overall mortality was significantly higher in patients who developed HCAI than non-HCAI (50.9% versus 21.3%, P<0.01).Conclusions: HCAI rates were higher than developed countries. VAP was the most common HCAI followed by BSI. HCAI increased the length of stay and mortality (P<0.01). Organisms isolated in HCAI were more resistant than non-HCAI isolates.