Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Januel, Jean-Marie; Harbarth, Stéphan Juergen; Allard, R. W.; Voirin, Nicolas; Lepape, Alain; Allaouchiche, Bernard; Guérin, Claude; Lehot, Jean‐Jacques; Robert, M; Fournier, G.; Jacques, Didier; Chassard, D.; Gueugniaud, Pierre‐Yves; Artru, F; Petit, Paul; Robert, Dominique; Mohammedi, I.; Girard, R.; Cêtre, J.-C.; Nicolle, Marie-Christine; Grando, J.; Fabry, J.; Vanhems, Philippe

doi:10.1086/650754

Cited by 38 publications

(28 citation statements)

References 39 publications

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“…It has been reported from different studies that lower age, malnutrition, underlying diseases, P. aeruginosa infections, and VAP are related to the higher mortality rates of NIs (3,7,(25)(26)(27)(28). The presence of various risk factors in our study group, the predominance of VAP, and antibiotic-resistant Gram-negative pathogens, especially P. aeruginosa, as etiological agents were related to the high mortality rate.…”

mentioning

confidence: 48%

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

Balaban¹,

Tanır²,

Timur³

et al. 2012

Jpn J Infect Dis

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SUMMARY:The aims of this study were to determine the prevalence, type, and clinical features of nosocomial infections (NIs), their etiological distribution, and the antibiotic resistance patterns of causative organisms in the general pediatric wards of a hospital in Turkey over a 3-year period. The Hospital Infection Control Committee NI surveillance reports were used as a database. NIs were detected in 171 (2.25z) of the 7,594 hospitalized patients. Some of these patients experienced more than 1 episode, and thus, the total NI episodes were 229. Patients' age varied from 1 to 144 months (mean ± standard deviation, 14.5 ± 23.6 months). The NI rate was 3.02z, and the NI density was 3.17/1,000 patient days. The most frequent NIs were lower respiratory system infections, blood stream infections, and urinary tract infections. Gram-negative organisms were the most frequently isolated agents. Of the 171 patients with NIs, 47 (27.5z) died.Nosocomial infections (NIs) are the major causes of prolonged hospital stays, increased costs, the increased resistance of organisms to antimicrobials, and mortality in hospitalized adults and children. NIs in pediatric and adult patients differ with respect to the sites of infection and the types of pathogens. In addition, NIs differ by country, region, hospital, and type of units, such as wards or intensive care units (1). There exist many reports on epidemiology, risk factors, and preventive measures for adult NIs. However, studies that focus on the pediatric population, particularly in developing countries, are limited. For this reason, we investigated the epidemiological, microbiological, and clinical features of NIs in the general wards of a pediatric hospital that does not have a pediatric intensive care unit (PICU) facility.Immunocompetent patients who were aged from 1 month to 18 years and had been admitted for miscellaneous diseases and developed a NI between January 2005 and January 2008 in a hospital in Turkey were retrospectively evaluated. The patients who had positive bacterial culture results or had negative culture results but clinical features of infection were included. A positive blood culture that was taken at least 72 h after the preceding positive blood culture was assessed as a new NI episode. The Hospital Infection Control Committee (HICC) NI surveillance reports were used as the database. NIs were defined on the basis of the Centers for Disease Control and Prevention (CDC) criteria (2). Crude NI rates were calculated with the following formula: NI rate ＝ (infection number/admitted or discharged patient number) × 100, and NI density was caluculated with the following formula: density ＝ (infection number/patient day) × 1,000 for each year and ward. The ventilator-associated pneumonia (VAP) rate was calculated with the following formula: VAP rate ＝ (VAP number/mechanical ventilator day) × 1,000. The NIs of each patient were classified according to the infection sites. Standard methods were used for microbiologic, biochemical, and radiologic investigations. Antib...

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confidence: 48%

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

Balaban¹,

Tanır²,

Timur³

et al. 2012

Jpn J Infect Dis

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“…[1][2][3] Although the neonatal and paediatric HAI burden is well described in high-income settings (4 -8% prevalence), [4,5] the HAI burden in most African countries is unquantified. In a meta-analysis of HAI in low-middle-income countries (LMIC), the World Health Organization (WHO) identified only three studies of neonatal/paediatric HAI from Africa between 1995 and 2008 (none from South Africa (SA)).…”

Section: In Practicementioning

confidence: 99%

A framework for preventing healthcare-associated infection in neonates and children in South Africa

2017

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Healthcare-associated infection (HAI) is a frequent and serious complication affecting 4 -8% of hospitalised children and neonates in high-income countries. The burden of HAI in South African (SA) paediatric and neonatal wards is substantial but underappreciated, owing to a lack of HAI surveillance and reporting. Maternal and child health and infection prevention are priority areas for healthcare quality improvement in the National Core Standards programme. Despite increasing recognition in SA, infection prevention efforts targeting hospitalised children and neonates are hampered by health system, institutional and individual patient factors. To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in hospitalised neonates and children.

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“…Nosocomial infections (NIs) are a major threat for hospitalized patients, particularly in intensive care units (ICUs), because they are associated with increased mortality and morbidity [1,2]. Analysis of data from large multicenter studies has the potential to improve our understanding of how patient- and ICU-level characteristics impact NI outcomes.…”

Section: Introductionmentioning

confidence: 99%

Multilevel competing risk models to evaluate the risk of nosocomial infection

et al. 2014

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IntroductionRisk factor analyses for nosocomial infections (NIs) are complex. First, due to competing events for NI, the association between risk factors of NI as measured using hazard rates may not coincide with the association using cumulative probability (risk). Second, patients from the same intensive care unit (ICU) who share the same environmental exposure are likely to be more similar with regard to risk factors predisposing to a NI than patients from different ICUs. We aimed to develop an analytical approach to account for both features and to use it to evaluate associations between patient- and ICU-level characteristics with both rates of NI and competing risks and with the cumulative probability of infection.MethodsWe considered a multicenter database of 159 intensive care units containing 109,216 admissions (813,739 admission-days) from the Spanish HELICS-ENVIN ICU network. We analyzed the data using two models: an etiologic model (rate based) and a predictive model (risk based). In both models, random effects (shared frailties) were introduced to assess heterogeneity. Death and discharge without NI are treated as competing events for NI.ResultsThere was a large heterogeneity across ICUs in NI hazard rates, which remained after accounting for multilevel risk factors, meaning that there are remaining unobserved ICU-specific factors that influence NI occurrence. Heterogeneity across ICUs in terms of cumulative probability of NI was even more pronounced. Several risk factors had markedly different associations in the rate-based and risk-based models. For some, the associations differed in magnitude. For example, high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were associated with modest increases in the rate of nosocomial bacteremia, but large increases in the risk. Others differed in sign, for example respiratory vs cardiovascular diagnostic categories were associated with a reduced rate of nosocomial bacteremia, but an increased risk.ConclusionsA combination of competing risks and multilevel models is required to understand direct and indirect risk factors for NI and distinguish patient-level from ICU-level factors.

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Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Cited by 38 publications

References 39 publications

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

A framework for preventing healthcare-associated infection in neonates and children in South Africa

Multilevel competing risk models to evaluate the risk of nosocomial infection

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