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Pediatr Infect Dis J. 2018 Aug;37(8):768-772. doi: 10.1097/INF.0000000000001884.

The Epidemiology of Healthcare-associated Infections in Pediatric Cardiac Intensive Care Units.

Author information

1
From the Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
3
Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, Lucille Packard Children's Hospital, Palo Alto, California.
4
Cardiac Intensive Care Unit, Lucille Packard Children's Hospital, Palo Alto, California, Stanford University School of Medicine, Stanford, California, and Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
Division of Cardiac Critical Care, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania.
6
Department of Pediatrics and Communicable Diseases, Division of Cardiology, C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Michigan.
7
Department of Pediatrics, The Children's Heart Program of South Carolina, Medical University of South Carolina, Charleston, South Carolina.
8
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, Ann Arbor, Michigan.
9
Department of Pediatric Critical Care Medicine, University of Pittsburg, Pittsburg, Pennsylvania.

Abstract

BACKGROUND:

Healthcare-associated infections (HAIs) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAIs are associated with increased morbidity, mortality and resource utilization. There are few studies describing the epidemiology of HAIs across the entire spectrum of patients (surgical and nonsurgical) receiving care in dedicated pediatric CICUs.

METHODS:

Retrospective analyses of 22,839 CICU encounters from October 2013 to September 2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry.

RESULTS:

HAIs occurred in 2.4% of CICU encounters at a rate of 3.3 HAIs/1000 CICU days, with 73% of HAIs occurring in children <1 year. Eighty encounters (14%) had ≥2 HAIs. Aggregate rates for the 4 primary HAIs are as follows: central line-associated blood stream infection, 1.1/1000 line days; catheter-associated urinary tract infections, 1.5/1000 catheter days; ventilator-associated pneumonia, 1.9/1000 ventilator days; surgical site infections, 0.81/100 operations. Surgical and nonsurgical patients had similar HAIs rates/1000 CICU days. Incidence was twice as high in surgical encounters and increased with surgical complexity; postoperative infection occurred in 2.8% of encounters. Prematurity, younger age, presence of congenital anomaly, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT) 4-5 surgery, admission with an active medical condition, open sternum and extracorporeal membrane oxygenation were independently associated with HAIs. In univariable analysis, HAI was associated with longer hospital length of stay and durations of urinary catheter, central venous catheter and ventilation. Mortality was 24.4% in patients with HAIs versus 3.4% in those without, P < 0.0001.

CONCLUSIONS:

We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.

PMID:
29280785
PMCID:
PMC6019633
[Available on 2019-08-01]
DOI:
10.1097/INF.0000000000001884

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