Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study

Abstract

Objective: To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods: A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a highcomplexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results: There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. Conclusion: The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulasenegative Staphylococcus.

The Etiologic Organisms, Risk Factors, and Outcomes of Nosocomial Bloodstream Infections in Pediatric Patients

“…5 Children are more susceptible than adults because of their immature immune systems and impaired innate and adaptive defenses caused by acute illnesses. 6 A recent multicenter pediatric study in Europe showed that HAIs are the highest in children in the first year of life, underscoring the importance of bloodstream infections as the most common type of HAI in children, similar to previous pediatric studies. 2,3 The identification of pediatric-specific risk factors for infections and solutions needed to prevent pediatric HAIs have not been thoroughly studied.…”

“…Numerous risk variables, such as underlying diseases, serious illnesses, increased duration of hospital stay, gastrointestinal surgeries, and invasive devices, have been linked to nosocomial bloodstream infections (nBSIs) due to drug-resistant bacteria in adult studies 5 . Children are more susceptible than adults because of their immature immune systems and impaired innate and adaptive defenses caused by acute illnesses 6 . A recent multicenter pediatric study in Europe showed that HAIs are the highest in children in the first year of life, underscoring the importance of bloodstream infections as the most common type of HAI in children, similar to previous pediatric studies 2,3 .…”

Dose reductions in immunoglobulin replacement are associated with increased antibiotic usage in patients with antibody deficiency

“…This is undesirable: an increased frequency of infection is associated with reduced health-related quality of life in patients with immunodeficiency 9 and incurs additional healthcare costs. Furthermore, the prevalence of antibiotic resistance organisms is increased in individuals with immunodeficiency 10,11 ; antibiotic stewardship should also be considered in IgRT dose decision-making.…”

Prevalência De Bactérias Multirresistentes Em Hemoculturas De Recém-Nascidos Do Hospital Universitário De Florianópolis-Sc

“…O aumento na detecção de bactérias MDR em pacientes de UTI pediátrica, reportado por diversos autores (Le Doare et al, 2015;Oliveira, P. et al, 2019;Silva et al, 2022), é um fator extremamente limitante na sobrevida de RN (Zhang et al, 2022). Nesse cenário, o monitoramento contínuo do perfil de resistência das cepas isoladas no ambiente hospitalar torna-se fundamental.…”