This article is more than 5 years old. Information may no longer be current.
Respiratory infections common in pediatric long-term care settings
Respiratory tract infections are the most commonly acquired viral illness among pediatric residents in long-term care facilities; however, the modifiable risk factors for these infections are unknown.
“Infections are a leading cause of morbidity and mortality in pediatric long-term care facilities,” Lisa Saiman, MD, MPH, from the department of pediatrics at Columbia University Medical Center and the department of infection prevention and control at New York Presbyterian Hospital, and colleagues wrote. “However, few recent studies have evaluated the incidence of bacterial and viral infections diagnosed in [these residents], particularly in the era of commercially available multiplex transcriptase-polymerase chain reaction (RT-PCR) assays for viruses.”
To assess infection rates of patients in long-term care, the researchers conducted a prospective cohort study that also focused on calculating infection rates and risk factors for respiratory tract infection. The study, which was under the Keep It Clean for Kids trial, took place between September 1, 2012, and December 31, 2015, and included three different facilities. All residents 21 years and younger, as well as those admitted during the study (n = 717), were included in the analysis.
The researchers reviewed medical records of the patients to identify infections acquired and diagnosed by clinicians on-site. Additionally, the risk factors for respiratory tract infection were measured using generalized linear mixed method regression modeling.
The median age of those included in the study was 2.6 years (0.4-9.1), and 49.9% were male. Medical technologies, including feeding tubes (n = 428) and tracheostomies (n = 215), were used for many of the patients included. Chronic comorbid conditions were also observed in the majority of residents, which ranged from musculoskeletal or ambulation (74.2%), neurologic (70.4%), respiratory (50.3%) and gastrointestinal (32.1%) disorders. Over 60% had four or more chronic comorbid conditions.
Of the 2,052 infections diagnosed within the 3-year time frame, 62.9% were respiratory tract infections. Although the overall infection rate was 5.3 infections per 1,000 resident days, the respiratory tract infection rate was observed at 3.3 infections per 1,000 resident days. The rates of respiratory tract, skin and soft tissue, urinary tract and bloodstream infections varied by site.
Those who are younger (IRR, 1.05; 95% CI, 1.03-1.06), had multiple chronic comorbid conditions (IRR, 1.12; 95% CI, 1.06-1.19), and had feeding tubes (IRR, 1.34; 95% CI, 1.03-1.64) and tracheostomies (IRR 1.40; 95% CI, 1.17-1.69) had respiratory tract infections in a multivariable model.
“These data contrast with the types of infections reported among adults residing in long-term care facilities and children in acute-care populations,” Saiman and colleagues wrote. “Urinary tract infections are the most common infection in adults, whereas pneumonia, surgical-site infections and gastrointestinal infections — including Clostridium difficile — are the most commonly reported infections among hospitalized children.” – by Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.
