No abstract

Objective:To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs).Design:A systematic review and meta-analysis.Methods:A systematic search (January 2000–September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case–control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated.Results:In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70–20.11) and the pooled attributable mortality rate was 8% (95% CI, 6–9). A meta-analysis was not conducted for cost due to lack of eligible studies.Conclusions:Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.

Background: Pregnant women are at risk for influenza-related complications, while their children are at risk for influenza or pertussis associated morbidity 1 . Influenza and pertussis vaccination is proven safe and effective during pregnancy, while recommendation from maternity care providers is strongly associated with vaccine uptakes 2,3 . Moreover, counseling of pregnant women on congenital infections is important. Objective: To investigate Greek providers' knowledge, attitudes and practices around congenital and neonatal diseases' screening, prevention and vaccination strategies. Methods: A pilot questionnaire was distributed through Survey Monkey to a convenient sample of Obstetricians/Gynecologists (Ob/ Gyns). Moreover, it was completed by a convenient sample of Midwives, during their annual meeting. Results :• In total, 202 responded: -102 Ob/ Gyns (72.5% > 40 years old, 23.7% female) and -100 Midwives (23.5% >40 years old, 98% female).• Both Ob/ Gyns and Midwives claimed discussing congenital infection prevention strategies during prenatal visits (90%), specifically hand hygiene (94.5%) and eating properly washed vegetables and well-cooked meat (97.5%). Fewer though advised pregnant women to avoid young children's saliva (58.7%) and gardening without gloves (58.3%).• The majority of providers tested pregnant women during the 1 st trimester for antibodies against CMV and Toxoplasma and retested if seronegative (97% and 85% respectively).• Regarding pregnancy, postpartum and family vaccination, many providers suggested influenza vaccine (73.8%, 65% and 61.4% respectively). Then again, most do not recommend pertussis vaccine (64.3%, 69% and 64.2% respectively).•Univariate analysis: -Ob/ Gyns: suggesting avoidance of young children's' saliva during pregnancy was associated with recommendation of gardening with gloves (p=0.016) and also providers who retested a seronegative woman were more likely to retest her every trimester (p<0.001).-Midwives: age <40 years old was associated with non-recommendation of pregnancy, postpartum and family pertussis vaccination (p=0.008, 0.008 and 0.05 respectively), while Midwives believed that antibodies should be retested every trimester and at the end of pregnancy if CMV and toxoplasma seronegative (p<0.001 both).-Both specialties: vaccinating pregnant women against influenza was associated with postpartum and family influenza vaccination (p<0.001 both).-Comparing the two specialty groups: Ob/ Gyns were more likely than Midwives, to discuss congenital infection prevention strategies during prenatal visits, like suggesting gardening with gloves, to retest pregnant women for CMV and Toxoplasma antibodies if seronegative at 1 st trimester and to suggest pregnancy, postpartum and family influenza vaccination, but not pregnancy pertussis vaccination (Table 1).• Multiple logistic regression analysis revealed that specialty and suggestion of avoiding children's saliva during pregnancy were independently associated with discussion of congenital infection prevention strategies durin...

Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 CLABSIs and nine non-CLABSIs died (23.4 vs. 9.6%, respectively, p = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4–24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = − 1.4–41.8%), without reaching, however, statistical significance. After multiple logistic regression, CLABSIs were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28–14.36, p = 0.018). Survival analysis showed no difference in time to death after study enrollment between CLABSIs and non-CLABSIs (log-rank p = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.