Nosocomial infection in a pediatric intensive care unit in a developing country

Abramczyk, Marcelo Luiz; Carvalho, Werther Brunow de; Carvalho, Eduardo S.; Medeiros, Eduardo Alexandrino Sérvolo de

doi:10.1590/s1413-86702003000600004

Cited by 78 publications

(73 citation statements)

References 16 publications

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“…8 In Brazil, one investigation reported a higher frequency of nosocomial infections in children younger than 2 years admitted to a PICU. 9 In this study, there was no significant difference between the average ages of cases and controls. However, when categorizing age into three ranges, there was a higher incidence of cases in one to two year old children.…”

Section: Agecontrasting

confidence: 48%

Risk Factors for Central Venous Catheter-Related Infections in Pediatric Intensive Care

Vilela¹,

Jácomo²,

Tresoldi³

2007

Clinics

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Vilela R, Jácomo ADN, Tresoldi AT. Risk factors for central venous catheter-related infections in pediatric intensive care. Clinics. 2007;62(5):537-44. OBJECTIVES:To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.

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Section: Agecontrasting

confidence: 48%

Risk Factors for Central Venous Catheter-Related Infections in Pediatric Intensive Care

Vilela¹,

Jácomo²,

Tresoldi³

2007

Clinics

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“…[1][2][3][4][5] A rate of 11.6 VAP episodes per 1000 days of mechanical ventilation in a pediatric intensive care unit (PICU) in the United States has been reported. 6 In studies in Mexico 7 and Brazil, 8 rates were 28 and 18.7 episodes, respectively, per 1000 days of mechanical ventilation. Results from the US National Nosocomial Infections Surveillance System indicate that pneumonia accounts for approximately 15% of all hospital-associated infections, ranging from 4.7 cases in PICUs to 34.4 cases in burn ICUs.…”

mentioning

confidence: 98%

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Kusahara

Carvalho

Núñez

et al. 2009

American Journal of Critical Care

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Background Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. Objective To compare the oropharyngeal microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ven ti lation who had pharmacological or nonpharmacological oral care. Methods A randomized and controlled study was performed in a pediatric intensive unit in São Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n = 27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n = 29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge. Results The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species. The 2 groups did not differ significantly in the colonization of normal (P = .72) or pathogenic (P = .62) flora, in the duration of mechanical ventilation (P = .67), or in length of stay in the intensive care (P = . Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the incidence of ventilator-associated pneumonia in the pediatric intensive care unit (PICU) patient population.2. Identify microorganisms that commonly colonize the oropharynx of PICU patients.3. Recognize the impact of an oral care routine using chlorhexidine on a PICU study group.

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“…Patients undergoing cardiovascular surgery had the highest hospital-acquired infection rate of 23 per 1000 patients. Several studies have reported that the prevalence of NIs in pediatric ICUs ranges between 6.1% and 29.6% (1,7) . The NI rate in our pediatric cardiovascular surgery intensive care unit was found 6.4% (54/838), which was acceptable according to the limited reports from National Nosocomial Infection Surveillance System gathering data from over 50 PICUs in the US (8) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Properties, Pathogens, and Mortality-Related Risk Factors of Nosocomial Infections in Pediatric Cardiovascular Surgery Intensive Care Unit

Karaağaç¹

2017

Kosuyolu Heart Journal

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Introduction:The aim of this study was to evaluate the properties, pathogens, mortality-related risk factors, and mortality rates of nosocomial infections (NIs) in the pediatric cardiovascular surgery intensive care unit. Patients and Methods:The files of 838 children, aged 0-16 years, who underwent cardiovascular surgery between January, 2014 and January, 2016 in Kartal Koşuyolu Research Hospital were evaluated in this retrospective study. NI was diagnosed according to the Center for Disease Control criteria. The correlations between several risk factors and NI were statistically analyzed.Results: Fifty-four children out of 838 (6.4%) had NI. 29 of them (53.9%) had respiratory tract infections, 14 (24.8%) had urinary tract infections, 8 (15.7%) had bacteremia and 3 (5.6%) had wound site infections. The isolated pathogens were Klebsiella pneumoniae (20.4%), Pseudomonas aeruginosa (18.6%), Candida albicans (18.6%), Stenotrophomonas maltophilia (13.8%), Acinetobacter baumannii (10.5%), coagulasenegative staphylococci (9.1%), methicillin-resistant Staphylococcus aureus (MRSA, 3.6%), Serratia marcescens (1.8%), Citrobacter freundii (1.8%), and Providencia rettgeri (1.8%). The mortality rate due to NI was 13.7% (11/80). There was a statistically significant relationship between NIs and age and duration of mechanic ventilation (p< 0.05), but not between NIs and gender, accompanying abnormalities, and nasogastric feeding (p> 0.05). Conclusion:Gram-negative bacteria were the most common pathogens of NI, which caused mortality. Assessing the responsible pathogens and determining the risk factors will help us to develop effective infection control measures for reducing the morbidity and mortality rates.

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Nosocomial infection in a pediatric intensive care unit in a developing country

Cited by 78 publications

References 16 publications

Risk Factors for Central Venous Catheter-Related Infections in Pediatric Intensive Care

Risk Factors for Central Venous Catheter-Related Infections in Pediatric Intensive Care

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Evaluation of Properties, Pathogens, and Mortality-Related Risk Factors of Nosocomial Infections in Pediatric Cardiovascular Surgery Intensive Care Unit

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