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Bloodstream infections most common type of HAI in children
A recent point-prevalence survey identified that infection control should focus on prevention of bloodstream infections, especially among neonates and infants, because the burden of health care-associated infections is highest during first year of life.
“Point-prevalence surveys estimate the hospital-wide burden of health care-associated infections within a reasonable budget … and allow broader comparison of rates across a wider range of sociocultural contexts,” Walter Zingg, MD, from Imperial College London, and University of Geneva Hospitals in Switzerland, and colleagues wrote. “We aimed to calculate the prevalence of health care-associated infections among hospitalized children and adolescents in Europe; to describe the distribution of types of health care-associated infections in different pediatric settings and age groups; and to determine risk factors for health care-associated infections among hospitalized children and adolescents in Europe.”
Zingg and colleagues analyzed point-prevalence surveys in 1,149 acute care hospitals using pediatric data from the European Center for Disease Prevention and Control (ECDC) database. The surveys took place from May 2011 to November 2012 in EU Member States, Iceland, Norway and Croatia. Investigators included all pediatric patients aged 0 to 18 years still at the hospital at 8:00 a.m. on the day of the survey and who were not discharged at the time of the survey. They used a generalized linear mixed-effects model to calculate risk factors for development of HAIs, and adjusted prevalence for HAIs by clustering at the hospital and country level.
After assessing data for 17,273 children and adolescents from 29 countries, the researchers found 770 HAI reports in 726 children and adolescents, corresponding to a prevalence of 4.2% (95% CI, 3.7–4.8). The results showed that bloodstream infection was the most common type of HAI across almost all age groups (45%; 95% CI, 41-48.1) followed by lower respiratory tract infection (22%; 95% CI, 19.3-25.2).
Zingg and colleagues saw the highest prevalence of infections were in pediatric ICUs (15.5%; 95% CI 11.6-20.3) and neonatal ICUs (10.7%; 95% CI 9-12.7). Compared with neonates, children older than 11 months were less likely to develop an HAI. Independent risk factors include fatal disease, prolonged length of stay and the use of invasive medical devices. Of the 392 microorganisms reported for 342 HAIs, researchers found Enterobacteriaceae most frequently (15%).
“The prevalence of health care-associated infections in NICUs and PICUs in Europe remains unacceptably high. Bloodstream infections in neonates and children are associated with a high mortality and long-term adverse neurological outcomes,” Zingg and colleagues wrote. “Prevention of health care associated infections in children in Europe requires a multinational quality improvement-program, with a focus on NICUs and PICUs and on health care-associated bloodstream infections.”
In an accompanying editorial, Jean-Winoc Decousser, PhD, PharmD, from the laboratory of bacteriology and infection control at the University Paris-Est Créteil, wrote that some limitations could impact the assessments of HAIs in children. He explains that because the microbiological definitions of HAIs were originally established for adults, there should be efforts to modify microbiological criteria for children. Decousser recommends, “an extensive collaboration between pediatricians, microbiologists, and infection control specialists to improve knowledge of pathophysiology of hospital-associated bloodstream infections in neonates and the laboratory-based criteria for their diagnosis.” – by Savannah Demko
Disclosure: Zingg and colleagues report no relevant financial disclosures. Decousser reports no relevant financial disclosures.
