Device Exposure and Patient Risk Factors’ Impact on the Healthcare-Associated Infection Rates in PICUs

Abstract

Healthcare-associated infections related to device use (DA-HAIs) are a serious public health problem since they increase mortality, length of hospital stay and healthcare costs. We performed a multicenter, prospective study analyzing critically ill pediatric patients admitted to 26 Spanish pediatric intensive care units (PICUs) over a 3-month period each year from 2014 to 2019. To make comparisons and evaluate the influence of HAI Zero Bundles (care bundles that intend to reduce the DA-HAI rates to zero) on PICU HAI rates, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once most of the units had incorporated all the Zero Bundles). A total of 11,260 pediatric patients were included. There were 390 episodes of HAIs in 317 patients and the overall rate of HAIs was 6.3 per 1000 patient days. The DA-HAI distribution was: 2.46/1000 CVC days for central-line-associated bloodstream infections (CLABSIs), 5.75/1000 MV days for ventilator-associated pneumonia (VAP) and 3.6/1000 UC days for catheter-associated urinary tract infections (CAUTIs). Comparing the two periods, the HAI rate decreased (p = 0.061) as well as HAI episodes (p = 0.011). The results demonstrate that exposure to devices constitutes an extrinsic risk factor for acquiring HAIs. The multivariate analysis highlights previous bacterial colonization by multidrug-resistant (MDR) bacteria as the most important extrinsic risk factor for HAIs (OR 20.4; 95%CI 14.3–29.1). In conclusion, HAI Zero Bundles have been shown to decrease HAI rates, and the focus should be on the prompt removal of devices, especially in children with important intrinsic risk factors.

Risk Factors of Central Line-Associated Bloodstream Infection (CLABSI): A Prospective Study From a Paediatric Intensive Care Unit in South India

“…The observed 30.42 CABSIs per 1000 central venous catheter days in our study were lower than the 47.31 bloodstream infections associated with central venous catheterization per 1000 catheter days previously reported in the adult population [ 20 ]. We also observed a female predominance of CLABSI cases with no statistical significance in contrast to the results reported in previous studies [ 3 , 4 , 9 , 10 , 20 ]. We observed an overall mortality of 12.5% in patients with CLABSI compared to the mortality of 12.9% to 56% reported in patients with CLABSI in previous studies [ 10 - 13 ].…”

“…Central line-associated bloodstream infection (CLABSI) is the most common hospital-acquired infection (HAI) accounting for 20-30% of all HAIs, followed by ventilator-associated pneumonia (20-25%), catheterassociated urinary tract infection (15%), surgical site infection (11%) and others [1]. In developing countries like India, the incidence of CLABSI varies from over 15 per 1000 catheter days and accounts for around 12-15% risk of mortality [1][2][3][4][5][6][7][8][9][10][11][12]. Recent studies reported that factors such as young age, gender, high pediatric risk of mortality (PRISM III) score, malnutrition, total parenteral nutrition, number of relevant hematological factors, catheter-related factors such as the site of catheter insertion, duration of central venous catheterization, use of medications such as steroids and prophylactic antibiotics increases the risk of HAIs such as CLABSI [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…In developing countries like India, the incidence of CLABSI varies from over 15 per 1000 catheter days and accounts for around 12-15% risk of mortality [1][2][3][4][5][6][7][8][9][10][11][12]. Recent studies reported that factors such as young age, gender, high pediatric risk of mortality (PRISM III) score, malnutrition, total parenteral nutrition, number of relevant hematological factors, catheter-related factors such as the site of catheter insertion, duration of central venous catheterization, use of medications such as steroids and prophylactic antibiotics increases the risk of HAIs such as CLABSI [1][2][3][4][5][6][7][8][9][10][11][12]. Studies also reported that the majority of CLABSIs were caused by gramnegative organisms with Klebsiella pneumonia being the most common etiology [11][12][13][14][15].…”

Increase in Incidence Rates and Risk Factors for Multidrug Resistant Bacteria in Septic Children: A Nationwide Spanish Cohort Study (2013–2019)

“…Thus, even taking into consideration the low statistical power due to the small sample, these close values deserve our attention. Classically, intrahospital and community infections have been known to have different causative agents, and antibiotic guidelines for empiric antibiotic therapy were therefore written accordingly [11]. In our cohort, a high proportion of children with MDR-sepsis (67.4%) came from the community, although MDR bacteria were responsible for only 10.4% of community-onset sepsis.…”

“…Patients' demographic characteristics are summarized in Table 1. Overall, patients with sepsis had a median age of 11 months [4-55 months] and a PRISM III score 24 h after admission of 7 [3][4][5][6][7][8][9][10][11][12]. One hundred and forty-one (32.6%) patients had received antibiotic treatment in the 48 h prior to PICU admission.…”