Hospital infections in the pediatric intensive care unit; 4-year evaluation, 2010-2013

Abstract

Objective: The purpose of this study is to evaluate the healthcare-associated infections (HCAIs) in the pediatric intensive care unit (PICU) during a 4-year period.Material and Methods: Pediatric patients between the age of 28 days and 18 years were included in the study. The Center for Diseases Control 2008 criteria were used for the diagnosis of HCAI. During the 4-year period (2010-2013), the number of children admitted to PICU was 1884, and the total bed-days were 15,082 days.Results: During the 4-year period, 139 HCAI episodes occurred in 89 children. Of the admitted children, 4.7% had at least one HCAI attack. We found that the HCAI rate and HCAI density were 7.3%, and 9.2 per 1000 patient-days, respectively. Within the two groups, all PICU patients and patients with an HCAI attack, the ages were 75.69 +/- 71.24 (median: 48) and 36.85 +/- 48.78 (median: 17) months (p< 0.001), respectively, and the length of hospital stay was 8.00 +/- 16.84 (median: 3) and 109.49 +/- 119.98 (median: 75) days (p< 0.001), respectively. The percentage of females was 51% (960/1884) and 33% (46/139) (p= 0.013) in all children admitted to PICU and those with HCAI attacks, respectively. The duration from admission to HCAI was 61.33 +/- 81.51 (median: 36) days. The most common principal accompanying diseases of the patients with HCAI attacks were neurological disease (20.9%; 29/139), solid-tissue malignancy (14.4%; 20/139), heart disease (12.9%; 18/139), chronic pulmonary disease (11.5%; 16/139), and chronic renal disease (8.6%; 12/139). The three most frequent HCAI types were ventilator-associated pneumonia (VAP; 28%), bloodstream infections (22%; with 12% having catheter-related bloodstream infections and 10% having bacteremia), and catheter-related urinary tract infections (15%). There was meaningful culture positivity in 90 of the 139 HCAI episodes (64%).Conclusion: Our PICU-HCAI rates are lower than those in the other studies in Turkey, and they are comparable with other studies conducted in developed countries. Our HCAIs occurred in the patients with an average age of 3 years. The most frequent HCAIs were pneumonia (including VAP), bloodstream, and urinary tract infections, and many of them were related to catheters.