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Nosocomial bloodstream infections in kids drive negative outcomes, raise costs

Health care-acquired bloodstream infections in pediatric patients have a “significant impact” on mortality, length of stay and health care costs, according to findings published in Infection Control & Hospital Epidemiology.

“In the United States, [health care-acquired bloodstream infections (HA-BSIs)] are associated with the highest number of preventable deaths among health care-associated infections (HAIs) as well as the highest costs, ranging from $960 million to $18.2 billion annually,” the authors wrote. “Although strong evidence indicates that most HA-BSIs are preventable, pediatric and neonatal HA-BSI rates remain far above zero in many countries worldwide, highlighting the need to initiate further national and targeted prevention strategies.”

Sofia Karagiannidou, MD, MSc, of the Center for Clinical Epidemiology and Outcomes Research, Non-profit Civil Partnership, in Athens, and colleagues aimed to determine mortality, length of stay and health care costs associated with pediatric and neonatal HA-BSIs.

The researchers performed a systematic search in PubMed, Cochrane and CINAHL databases for case-control or cohort studies published between January 2000 and September 2018 that provided data on at least one of these criteria: attributable or excess length of stay, health care cost or mortality rate due to HA-BSI. They identified 21 studies that were included in the systematic review and 13 that were included in the meta-analysis.

Attributable mean length of stay ranged from 4 to 27.8 days, whereas health care costs ranged from $1,642.16 to $160,804 (in 2019 U.S. dollars) per patient with a HA-BSI. The mortality rate related to HA-BSIs ranged from 1.43% to 24%.

The pooled mean attributable hospital length of stay was 16.91 days (95% CI, 13.7-20.11), Karagiannidou and colleagues wrote. The pooled attributable mortality rate was 8% (95% CI, 6% to 9%).

Previous research suggests that 14% of hospital-acquired bloodstream infections are misclassified as HA-BSIs, which may lead to an underestimation of hospital infection risk.

“This finding justifies and may enhance efforts to implement HA-BSI prevention strategies,” the authors wrote. “Future research efforts could make better use of existing HAI definitions and evolving statistical methodologies, presenting more accurate, high-quality and comparable outcome results globally.” – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.

References:

Karagiannidou S, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.353.

Khatib R, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.245.