Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Abstract

BACKGROUND: Health care–associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network for central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS: A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94–0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94–0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93–0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92–0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS: Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.

Comparison of the New Adult Ventilator-Associated Event Criteria to the Centers for Disease Control and Prevention Pediatric Ventilator-Associated Pneumonia Definition (PNU2) in a Population of Pediatric Traumatic Brain Injury Patients*

“…(4, 6–9) Among pediatric patients suffering trauma, those with brain injuries are particularly susceptible to VAP. (7, 10, 11)…”

Central-line associated bloodstream infections in a tertiary care children’s University hospital: a prospective study

“…The 2014 report of the European Centre for Disease Prevention and Control (ECDC) estimated a mean device-adjusted rate in patients staying in an ICU for more than two days was 3.0 CLABSI episodes per 1000 central line-days (IQR: 0.5–4.1) [2]. A cohort study performed from 2007 to 2012 in 173 neonatal intensive care unit (NICU) and 64 PICU reporting data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network in United States, showed a reduction of CLABSI rates from 4.9 to 1.5/1000 central line-days in NICU and from 4.7 to 1.0/1000 central line-days in PICU in 5 years time [3]. A trend of infection rate reduction was seen also in a prospective 2-year quality improvement British project conducted in 21 PICU with overall 34,635 central line-days analyzed [4].…”

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

“…[1][2][3][4][5][6][7] Pediatric hospital patients are especially vulnerable to adverse outcomes from AR infections due to factors such as immature immune systems, acquired or congenital immunodeficiencies, need for chronic parenteral nutrition, and congenital anomalies. 8 The unique impact HAIs have on pediatric patients is underscored by the fact that rates of device-associated infections are higher in some pediatric unit types than in corresponding adult units, despite a lower device utilization ratio.…”

“…9 A recent analysis of device-associated infection data has demonstrated a decline in the incidence of central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia infections (VAPs) in pediatric units between 2007 and 2012. 6 However, data specifically describing antibiotic resistance among pathogens associated with pediatric device-associated infections and surgical site infections (SSIs) are lacking. 10 Providing data to inform HAI and antibiotic resistance prevention efforts is an essential function of the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN).…”