Infections In Pediatric Intensive Care Unit Research Articles

Outcome of high-flow nasal cannula (HFNC) therapy in respiratory failure due to lower respiratory tract infections in PICU - a single center experience in Karachi, Pakistan.

Objective: To evaluate the outcome of high-flow nasal cannula (HFNC) therapy by ROX index in critically ill children with acute respiratory failure due to lower respiratory tract infections in pediatric intensive care unit (PICU). Study Design: Analytical, Observational, Cross-sectional study. Setting: The PICU of the Indus Hospital, Karachi, Pakistan. Period: November 2022 to October 2023. Methods: We enrolled children of either gender, aged above 1 month up to 16 years and presenting with acute respiratory insufficiency due to lower respiratory tract infections. The use of HFNC was monitored for 72-hours. HFNC failure was characterized by requiring either noninvasive mechanical ventilation or invasive mechanical ventilation due to an unstable state. Results: In a total of 62 children, 39 (62.9%) were male. The mean age was 27.01±30.96 months. The most common diagnosis at the time of admission were pneumonia, and bronchiolitis noted in 25 (40.3%), and 33 (53.2%) children, respectively. Gradual improvement in ROX index was observed among children with HFNC success while a declining ROX index predicted HFNC failure. Outcome of HFNC was successful in 45 (72.6%) children. Mortality was observed in 12 (19.4%) children. Presence of comorbidity was significantly associated with unsuccessful HFNC outcomes. Conclusion: ROX index was found to be a good predictor of HFNC outcome. Overall, HFNC therapy in PICU demonstrated 72.6% success rate. HFNC outcomes are hampered particularly in cases involving comorbidities highlighting the need for tailored interventions.

Pathogens in PICU before and during the SARS-CoV-2 pandemic in China: a multicenter retrospective study

BackgroundNonpharmacological interventions for COVID-19 could reduce the incidence of children hospitalized in pediatric intensive care units (PICU) and the incidence of children with bacterial infections. This study aimed to evaluate changes in the bacterial profile of children in PICU before and during the COVID-19 pandemics.MethodsThis is a retrospective study, involving clinical data of children with positive bacterial cultures admitted to the PICU respectively in 2019 and 2021.ResultsIn total 652 children were included in this study. The total number of hospitalized patients and the incidence of bacteria-positive children in 2021 were lower than those in 2019. There were no significant differences in the ratio of Gram-positive bacterial infection, Gram-negative bacteria infection or fungi infection between the two years. The rate of Streptococcus pneumoniae in 2021 was higher than that in 2019(p = 0.127). The incidence of Haemophilus influenzae in hospitalized patients decreased with a downward trend(p = 0.002). The distribution of previous underlying diseases in children admitted to PICU with different outcomes of bacterial infection between the two years were homogeneous (p > 0.05).ConclusionAfter the implementation of COVID-19 isolation, prevention and control measures, the number of hospitalizations and bacterial infections in PICU decreased, which may be due to changes in population’s behavior patterns. Meanwhile, the incidence of Haemophilus influenzae in hospitalized patients decreased with a downward trend.

Clinico-Bacteriological study of Nosocomial Infections in the Paediatric Intensive Care Unit (PICU)

Background: In this study, we wanted to study the incidence, risk factors and clinical and bacteriological pattern of nosocomial infections in PICU. Methods: This study was conducted in the PICU of 900 bedded Tertiary hospital. 74 suspected cases of nosocomial infections were studied prospectively, identified as per the guidelines laid down by CDC. Results: The incidence of nosocomial infections was 29% (N=255). Bloodstream infections were the most commonly observed in the present study (43.24%, 32/74) followed by Urinary Tract Infection (UTI) (32.43%, 24/74), Nosocomial pneumonia (16.21%, 12/74), and SSI (8.1%, 6/74). There were two patients with more than one nosocomial infections. The average duration of stay in children with NI the overall length of stay was 589 days with an average of 7.95 days compared to 4.63 days in children without NI. Conclusions: The risk of nosocomial infection was directly related to the duration of stay in the PICU and the duration of placement of indwelling catheters /tubes. Age and sex were the important independent risk factors for causing nosocomial infections as the incidence was more in the 2 months age group. BSI occurred more commonly in males while UTI in females. Other risk factors like malnutrition, immuno-compromised status and underlying illness were also associated with nosocomial infections. The most common organism was E. coli (sensitive to amikacin) followed by klebsiella and maximum sensitivity to piperacillin-tazobactam. Length of stay in PICU more in children with NI. There was no significance in mortality between both groups. Abbreviations: NI- Nosocomial infections. PICU- Pediatric intensive care unit. UTI- Urinary tract infections.

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

ObjectivesTo measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. MethodsA retrospective chart review of children 0–14 years old admitted to PICU with a viral infection. ResultsOf 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). ConclusionViral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.

The Changes in Epidemiology of Imipenem-Resistant Acinetobacter baumannii Bacteremia in a Pediatric Intensive Care Unit for 17 Years

BackgroundAcinetobacter baumannii infections cause high morbidity and mortality in intensive care unit (ICU) patients. However, there are limited data on the changes of long-term epidemiology of imipenem resistance in A. baumannii bacteremia among pediatric ICU (PICU) patients.MethodsA retrospective review was performed on patients with A. baumannii bacteremia in PICU of a tertiary teaching hospital from 2000 to 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST), and polymerase chain reaction for antimicrobial resistance genes were performed for available isolates.ResultsA. baumannii bacteremia occurred in 27 patients; imipenem-sensitive A. baumannii (ISAB, n = 10, 37%) and imipenem-resistant A. baumannii (IRAB, n = 17, 63%). There was a clear shift in the antibiogram of A. baumannii during the study period. From 2000 to 2003, all isolates were ISAB (n = 6). From 2005 to 2008, both IRAB (n = 5) and ISAB (n = 4) were isolated. However, from 2009, all isolates were IRAB (n = 12). Ten isolates were available for additional test and confirmed as IRAB. MLST analysis showed that among 10 isolates, sequence type 138 was predominant (n = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. Of 27 bacteremia patients, 11 were male (41%), the median age at bacteremia onset was 5.2 years (range, 0–18.6 years). In 33% (9/27) of patients, A. baumannii was isolated from tracheal aspirate prior to development of bacteremia (median, 8 days; range, 5–124 days). The overall case-fatality rate was 63% (17/27) within 28 days. There was no statistical difference in the case fatality rate between ISAB and IRAB groups (50% vs. 71%; P = 0.422).ConclusionIRAB bacteremia causes serious threat in patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial for managing IRAB infection in PICU.

Risk Factors of Polymicrobial Bloodstream Infections in Pediatric Intensive Care Unit Patients

Background: Sepsis continues to present a significant problem in the pediatric intensive care unit (PICU) worldwide. Sepsis in pediatric infants is an important cause of morbidity and mortality. The risk of sepsis increases with decreasing chronological age and weight. Objective: To identify of the risk factors of polymicrobial BSIs in pediatric patients with intravascular devices, via conducting the objectives, which were evaluating the frequency of monomicrobial and polymicrobial BSIs in pediatric patients. Patients and methods: This isobservational cross sectional study that was conducted in at PICU, General Zagazig Hospital, carried on 90 pediatric patients who were divided into 4 groups: group (I) oncology patients, group (II) cardiac patients, group (III) gastrointestinal (GIT) patients and group (IV) miscellaneous patients. Results: Our results showed that 50% of polymicrobial infection patients had cardiac disease, 25% had gastrointestinal disease. 25% had renal failure. 100% of the cardiac patients and the gastrointestinal patients had respiratory cause of admission to PICU. Conclusion: Steroids given to the patients, endotracheal intubation, central venous catheter (CVC), congenital heart diseases (CHD) and H2 blocker were the most common risk factors for polymicrobial infection in PICU.

Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting.

Candida infection was previously thought to be rare in intensive care. With the increased use of broad-spectrum antibiotics, the incidence of candida infection increased significantly. Case-control study was done in patients ≤18 years of age treated for 3 days or more in Pediatric Intensive Care Unit (PICU) Dr. Sardjito General Hospital, Yogyakarta from January 2014 to December 2016. Overall, 43 children were included in this study as a case group with positive candida culture and 43 children as a control group with no candida culture. Cut off point of candida score is ≥3 from our subjects. The area under curve (AUC) value for cut off ≥3 was moderate (0,72). Candida score ≥3 has an odd ratio (OR) 6.8 (95% CI 2.4-18.6) with P < .05. All of confounding factors in candida infection have no association with P > .05. Candida score can be used as predictor of candida infection in PICU.

Efficacy of chlorhexidine wipes on colonization of Pseudomonas aeruginosa and Staphylococcus aureus in both ventilator and nonventilator patients in pediatric intensive care unit.

In this coronavirus disease 2019 pandemic, pediatric children who are admitted in the intensive care unit (ICU) are more susceptible to ventilator-associated pneumonia. Ventilator-associated pneumonia is the second-most common hospital-acquired infection in pediatric ICU. Oral hygiene maintenance is a challenge here. To maintain oral hygiene and to prevent colonization of microorganisms such as Pseudomonas aeruginosa and Staphylococcus aureus which cause ventilator-associated pneumonia, a study was conducted, which aimed at finding the efficacy of chlorhexidine (CHX) wipes (as an oral hygiene aid) on colonization of these organisms in pediatric ICU. The study was conducted among twenty children (8 in ventilation and 12 without ventilation) in the age range of 6-14 years admitted in the pediatric ICU. Swab sample was taken on the 1st day from both groups. Culturing of swab sample was done for colonization of microorganisms. CHX gluconate with a concentration of 0.2% was used as wipes. Swab sample was collected at the end of the 2nd day. Culturing of swab sample was done for colonization of microorganisms. Statistical analysis was done. A statistically significant difference (P ≤ 0.04) was seen in the ventilator group with a mean of 0.75 ± 13.241 in the reduction of S. aureus count. P. aeruginosa growth was not seen in either of the groups before or after the use of CHX wipe. Standard oral hygiene practice has the potential to contribute to improved oral and general health of children in pediatric ICU. CHX wipes significantly reduced S. aureus count in ventilator patients. Hence, it could be used as an effective antimicrobial agent in pediatric ICU.

Zinc supplementation reduces Candida infections in pediatric intensive care unit: a randomized placebo-controlled clinical trial.

Resistance to anti-fungal drugs has become the main cause for increasing incidence rate of Candida infections in pediatric intensive care units (PICU). Zinc supplementation has been shown to exhibit beneficial effects on many pediatric illnesses. This study aimed to investigate the efficacy of zinc supplementation on prevalence of candidemia and candiduria infections in PICU. 724 eligible children between 1 to 5 years old admitted in PICU were randomly assigned into either zinc supplementation group or placebo group. Primary endpoints were the number of Candida infections, length of PICU stay and cases of patient death 14 days after enrollment. Secondary endpoints were the incidence rates of candidemia and candiduria. The incidences of candiduria and candidemia were significantly lower in the zinc group than the placebo group. The length of PICU stay and cases of patient death were obviously lowered in the zinc group compared to the placebo group. In conclusion, zinc supplementation shows beneficial clinical efficacy in reducing Candida infections among PICU patients on broad-spectrum antibiotics with critical illnesses.

Abstract P-191: A MAJOR CLINICAL CHALLENGE IN PEDIATRIC INTENSIVE CARE UNIT WITH PANDRUG-RESISTANT OXA-48 KLEBSIELLA PNEUMONIAE OUTBREAK

Aims & Objectives: Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been reported to cause serious outbreaks. In our knowledge it is the first study about pandrug-resistant (PDR) OXA-48 positive CRKP infection in pediatric intensive care unit (PICU). Aim: To share our experience with PDR-CRKP outbreak with survival rate of 14% mortality in our clinic. Methods Between September 2016 and January 2017, PDR Klebsiella pneumoniae outbreak in a 20-bed tertiary PICU was evaluated prospectively. Demographic characteristics, underlying diseases, invasive procedures, previous infection and antibiotics usage, infection center, applying therapies and measures are recorded. Results 7 patients (6 male, 1 female) were followed for PDR OXA-48 positive CRKP. The mean age of the patients was 6 years, the mean time of appearance of infection in PICU was 45 days. Infection was detected in tracheal aspirate culture in 2 patients, catheter-related blood culture in 2, wound culture in 2, and urine culture in 1 patient. Combination therapy with high dose meropenem and imipenem infusion, amikacin, colistin and tigecycline was used in treatment. The mean duration of antibiotic treatment and isolation was 15.7 and 65.4 days, respectively. Skin and digestive tract colonization occurred in all patients. Only one patient lost becouse of her own illness, while there was no active infection. Conclusions PDR-CRKP infection is the most serious form of nasocomial outbreaks for intensive care units due to high mortality rate. We wanted to share our experience, which was for the first time in the PICU with very low mortality.

Transfusion of red blood cells as risk predictor for nosocomial infections in pediatric intensive care units

Background: Transfusion of red blood cells (RBCs) is a common intervention in Pediatric Intensive Care Units (PICU) due to anemia occurring in over one-third of children hospitalized there. Objectives: To establish the relation between transfusion of RBCs and nosocomial infections in PICU and evaluate its impact on absolute lymphocytic count. Patients and methods: A case-control study carried out on 200 critically ill children admitted to PICU, of which one hundred received blood transfusion and one hundred did not. All patients underwent history taking and clinical examination. Results: A statistically significant higher prevalence of mechanical ventilation, central venous catheterization, PRISM score and longer PICU length of stay were observed in the transfused group compared with the non-transfused group (P < 0.001). Nosocomial infections were present in 62% patients in the transfused group and in 32% patients in the non-transfused group (P < 0.05), including nosocomial pneumonia, bacteremia, and urinary tract infection. Mechanical ventilation, presence of central venous catheter, number and age of transfused RBCs were risk predictors for nosocomial infections. Lymphopenia was evident in the transfused group. Conclusion: Nosocomial infections are related with red blood cells transfusion in patients hospitalized in PICU. Mechanical ventilation, presence of central venous catheter, number and age of transfused RBCs, and lymphopenia were risk predictors for nosocomial infections.

Antifungal Susceptibility of Planktonic Cells and Biofilms of Candida Tropicalis Isolated from Hospital Acquired Infections in Pediatric Intensive Care Units

Background: Candida tropicalis is one of the main non albicans Candida which is implicated in many serious infections. Biofilm formation is an important virulence factor in Candida species. This study was designed to determine the ability of C. tropicalis isolated from infected patients in Pediatric Intensive Care Units (PICUs) to form biofilm, also to test the antifungal susceptibility of Candida tropicalis planktonic cells and biofilms. Methodology: Candida tropicalis isolates were collected from patients suffering from hospital acquired infections in PICUs of Mansoura University Children hospital. The isolates were identified by Analytic Profile Index (API) 20 C. The ability of the isolates to form biofilm was measured by crystal violet assay. The susceptibility of planktonic cells and the biofilms to amphotricin B and fluconazole was determined according to Clinical and Laboratory Standards Institute (CLSI) M27 A2 guidelines and by crystal violet assay respectively. Results : Thirty seven isolates of C. tropicalis were detected during period of study. About sixty percent of the isolates (23 isolates) were biofilm producers. All planktonic cells were susceptible to amphotricin B and 27 isolates (73%) were susceptible to fluconazole. All biofilm cells were resistant to amphotricin B and fluconazole. Conclusion: The biofilm cells expressed higher resistance to the tested antifungal agents more than planktonic cells. Formation of biofilm may represent an important cause of the poor response of infections caused by C. tropicalis to amphotricin B and fluconazole therapy.

Influence of supplemental parenteral nutrition approach on nosocomial infection in pediatric intensive care unit of Emergency Department: a retrospective study.

Background & aimsNutritional support for patients in the intensive-care unit (ICU) is a part of standard care which promotes medical quality and decreases nosocomial infection. Supplemental parenteral nutrition (SPN) approach (enteral nutrition (EN) combined with parenteral nutrition (PN) when EN alone is insufficient) has become one major concern in nutrition research field. This research aims to explore the following relationships: (i) the relationship between SPN and nosocomial infection, (ii) the relationship between early and late SPN initiation and the development of nosocomial infection.MethodsA retrospective study was conducted in patients who met the inclusion criteria from February 2012 to February 2015 in Pediatric ICU (PICU). Patients were classified into two groups according to nutrition delivery approach-SPN group and EN alone group. Then SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively. Age, gender, serum albumin at admission, severity of disease, length of stay in PICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in PICU of Emergency Department.Results204 patients were included in our study. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate (34.0 vs.10.9 %, p < 0.001). The late-initiation subgroup of SPN approach was found to be an independent predictor of nosocomial infection in the logistic regression analysis model (OR = 3.40; 95 % CI, 1.13 ~ 10.19; p = 0.029). Serum albumin at admission (OR = 0.91; 95 % CI, 0.84 ~ 0.97; p = 0.008), mechanical ventilation (OR = 3.85; 95 % CI, 1.43 ~ 10.39; p = 0.008), severity of disease (OR = 3.79; 95 % CI, 1.03 ~ 13.99; p = 0.045) and PICU length of stay (OR = 1.23; 95 % CI, 1.11 ~ 1.35; p < 0.001) were also identified as significant risk factors for nosocomial infection.ConclusionsOur study shows late-initiation SPN approach increases the incidence of nosocomial infection compared with early-initiation approach in critically ill children in PICU of Emergency Department. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate.

Invasive Fungal Infections in Infants—Focus on Anidulafungin

Introduction:Invasive fungal infection in pediatric intensive care units (PICU) is a rising challenge. Candida species are the most common microorganisms in these infections. Due to growing resistance against fluconazole, echinocandins are being used for the appropriate therapy. However, the recent IDSA guidelines recommend them only in cases where fluconazole or Amphotericin B cause treatment failure or are contraindicated. In a literature review, the importance of invasive fungal infections in PICU settings and the role of anidulafungin shall be examined.Materials and Methods:Articles were retrieved form PubMed covering the years 2000–2012. Various search terms were used. Then the articles were clustered in different types like ‘review,’ ‘pharmacokinetics,’ ‘case reports’ and others.Results:From 67 search results, 14 articles were selected. Of these, 7 were related to anidulafungin, while 7 were related to echinocandins or fungal infections in the PICU. Anidulafungin was examined in 4 PK/PD studies where a good safety profile was found. No serious adverse events occurred. The articles reporting risk factors show that central venous catheters, receipt of antibiotics, receipt of parenteral nutrition, and neutropenia are the most important independent risk factors for invasive fungal infections in PICU. Three reviews of antifungal agents show that echinocandins may be useful due to their safety profile; micafungin is the best examined one and further trials are needed.Discussion:The published literature on invasive fungal infections in PICU settings has grown over the years. There are only a few articles, however, which are directly related to the use of anidulafungin in this setting. A most recent publication showed good PK/PD dynamics and a good safety profile for anidulafungin. So far, no RCT in the area of invasive candidiasis in infants and neonates has been published. A review of currently registered trials at ClinicalTrials.gov has shown one more trial related to PK/PD and two trials that investigate the use of anidulafungin or anidulafungin in combination with Voriconazole in pediatrics.Conclusion:The small body of existing literature on anidulafungin in infants shows success in treatment, no drug-related adverse events, and good pharmacodynamics. A dosing of 0.75 mg/kg/day or 1.5 mg/kg/day is as effective as 50 mg/day or 100 mg/day in adults. More trials on the use in clinical reality of PICU or NICU should follow.

Risk factors for invasive fungal infection in pediatric intensive care unit

Objective To analyze the incidence,clinical feature and the risk factors of invasive fungal infection in pediatric intensive care unit (PICU). Methods We retrospectively summaried the invasive fungal infection in our PICU from Jan 2007 to Dec 2009 in order to analyze the incidence, clinical feature and the risk factors of invasive fungal infection in PICU. Multiple clinical data were collected such as pediatric critical illness score, mechanical ventilation, urinary drainage tube, indwelling gastric canal and continuous blood purification. Results ( 1 ) The incidence rate of invasive fungal infection was 1.65 % ( 35/2 116 ). The morbidity was 20. 00% ( 7/35 ). ( 2 ) Mean infected day was ( 10. 4 ±- 8. 3 ) d after admission. The clinical manifestations included fungal pneumonia( 60. 0% ), peritonitis ( 14. 3% ), urinary tract infection ( 11.4% ),intestinal tract infection(8. 6% ) ,sepsis(2. 9% ) and meningitis(2. 9% ). All of the patients had used broad spectrum antibiotic. (3) The risk factors of invasive fungal infection included lower pediatric critical illness score, mechanical ventilation, indwelling gastric tube, urinary drainage tube and continuous blood purification.(4) Candia albicans was the predominant pathogen in invasive fungal infection. Conclusion Invasive fungal infection has become one of the main nosocomial infection in PICU. Lung is most commonly involved and candida albicans is the major pathogen. Using antibiotics appropriately, decreasing unnecessary invasive performance,and rationally using antifungal agent mi.ght be effective strategy for invasive fungal infection in PICU. Key words: Invasive fungal infection; Risk factor; Intensive Care Unit; Children

Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina

ObjectiveTo determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.DesignProspective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.SettingSeventeen medical-surgical PICUs in tertiary care hospital in Argentina.PatientsAll consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.Measurements and main resultsOf 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3–59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO2 at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36–6.84); OR for ARD, 3.38, (CI 95% 1.45–10.33); OR for PaO2/FiO2, 4 (CI 95% 1.57–9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07–0.54).ConclusionsIn children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.

Extra Length of Stay of Nosocomial Infections in Pediatric ICUs of Colombia and Mexico. Findings of the International Nosocomial Infection Control Consortium (INICC)

BACKGROUND/OBJECTIVES: Our goal was to determine the extra length of stay (LOS) of the health care associated infections (HAI) at Pediatric intensive care units (ICU) of hospital members of the INICC in Colombia, and Mexico. METHODS: We conducted a case control analysis nested in a prospective cohort study in 4 Pediatric ICUs at 4 hospitals members of the INICC, to analyze the extra LOS of patients with central vascular catheter associated blood stream infection (CVC-BSI), mechanical ventilator associated pneumonia (VAP), and catheter associated urinary tract infection (CA-UTI). All patients were assessed for LOS. Patients with HAI were called cases, while those without HAI were called controls. HAIs were identified using the CDC-NNIS definitions. We calculated E-LOS subtracting nosocomial average length of stay (ALOS) of patients with and without HAI. RESULTS: From 2003 to 2005, we enrolled 379 patients, representing 2,543 bed days. The overall HAI rate was 10.0 per 100 patients and 14.9 per 1000 bed days. The CVC-BSI rate was 14.9 per 1000 CVC days, the VAP rate was 2.8 per 1000 device days, and CA-UTI rate was 3.4 per catheter days. LOS of patients without HAI was 5.5 days; LOS of patients with CVC-BSI was 15.0 days (RR, 2.73; 95% CI, 2.45-3.04; P, 0.0000), representing 9.5 extra days; LOS of patients with VAP was 8.7 days (RR, 1.58; 95% CI, 1.07-2.33; P, 0.0193), representing 3.2 extra days; and LOS of patients with CA-UTI was 23.6 days (RR, 4.30 ; 95% CI, 3.57-5.19; P, 0.0000), representing 18.1 extra days. CONCLUSIONS: This study has identified that CVC-BSI, VAP, and CA-UTI increase from 3.2 to 18.1 days the length of stay of patients at ICUs.