Nosocomial infections in brazilian pediatric patients: using a decision tree to identify high mortality groups

Abstract

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Survey of Obstetrics and Gynecology Residents Regarding Pneumococcal Vaccination in Pregnancy: Education, Knowledge, and Barriers to Vaccination

“…A review about the safety of maternal pneumococcal vaccination found no differences in stillbirth [ 9 , 16 ], spontaneous abortions [ 16 ], congenital birth defects [ 16 ], or prematurity rates [ 17 ] in women who were vaccinated compared to those who were not [ 18 ]. These studies only found the expected effects including local tenderness or pain [ 10 , 13 , 14 , 17 ], swelling [ 10 , 13 , 14 ], or fever [ 10 , 13 , 14 , 17 ]. Hence, all current studies support the safety of maternal pneumococcal vaccination.…”

Maternal Antibodies: Clinical Significance, Mechanism of Interference with Immune Responses, and Possible Vaccination Strategies

“…In principle, maternal immunization can be applied to other (live-attenuated) vaccines and infectious diseases as well. However, it has been reported that maternal immunization with a pneumococcal (polysaccharide) vaccine does not protect infants against clinical disease (165). …”

Metabolic and infectious pathologies in Brazilian medical literature: a review

“…Mukai et al 69 performed a spatial analysis of hospitalizations for pneumonia in the Vale do Paraiba region of Brazil that determined spatial autocorrelations and identified cities in which interventions are necessary regarding the number of hospitalizations for pneumonia in infants under one year of age. Lopes et al 70 studied the immunization of 139 mothers with pneumococcal capsular polysaccharide vaccine during pregnancy randomly allocated to receive/not receive 23-valent polysaccharide vaccines during or after pregnancy. Their offspring were monitored monthly over the first 6 months of life, and the results showed that providing the mother with a polysaccharide vaccination during pregnancy did not decrease pneumococcal colonization.…”