Multidrug‐resistant organisms in paediatric palliative care patients – Prevalence, risk factors and the impact of a liberal hygiene concept

Abstract

Aim Multidrug‐resistant organisms (MDRO) deserve special attention in health‐care facilities for children with life‐limiting conditions because these children have an increased risk for colonisation. To avoid nosocomial transmissions to other inpatients, single‐room isolation is usually recommended. In the context of paediatric palliative care (PPC), such isolation counters the aim of participation in social activities for the patients. This study aimed to determine the prevalence of MDRO, the predictive value of risk factors and the incidence of nosocomial infections and nosocomial colonisations on a PPC inpatient unit applying a special hygiene concept that enables participation in social activities through risk‐adaption and barrier nursing. Methods Two‐year surveillance with MDRO screening of all intakes (N = 386) of a PPC unit on the day of admission and discharge. To determine the predictive value of pre‐defined risk factors, logistic regression analyses were calculated. Receiver operating characteristic analyses were performed to determine the predictive power of the number of risk factors on the presence of MDRO. Results The rate of MDRO colonisation at admission was 12.7%; previous positive MDRO screening was the only significant individual risk factor. Over the 2‐year period, no MDRO‐related nosocomial infections occurred; nosocomial colonisation incidence density was 0.6. Conclusion Results demonstrate that patients with at least one risk factor have to be cared for by barrier nursing until MDRO screening results are negative. Following these guidelines prevents nosocomial MDRO transmission.

Lower Respiratory Tract Infections in Pediatric Patients with Severe Neurological Impairments: Clinical Observations and Perspectives in a Palliative Care Unit

“…During the two-year observation period, we treated 33 cases of bacterial LRTI in 20 PPC patients with SNI. Overall, 165 individual patients were admitted on 386 occasions [ 40 ]. Inpatient treatment of bacterial LRTI accounted for 8.6% of all admissions or 12.1% of all patients, respectively.…”

“…In addition to efforts to prevent colonization and infection with hospital-acquired MDROs [ 40 , 56 ], antibiotic therapies in this patient population clearly foster the selection of MDROs. Although most reports investigating these issues, including ABS in children with SNIs, derive from secondary (post-acute) or long-term care facilities [ 57 , 58 , 59 ], ABS programs can reduce the occurrence and spread of MDRO in the long term [ 50 , 60 ].…”

Clinical recommendations for the inpatient management of lower respiratory tract infections in children and adolescents with severe neurological impairment in Germany

“…There is an increased prevalence of multidrug-resistant (MDR) bacteria colonizing pediatric patients with SNI [ 26 , 27 ]. This colonization often causes uncertainty about whether a different antibiotic therapy (ABT) is required for LRTI treatment [ 28 , 29 ].…”