Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

Abstract

Background Nosocomial infection remains an important health problem in long stay (> 3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher PRISM III score, the diagnoses of trauma or cardiac arrest, and lymphopenia (p < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (p < 0.05). In multivariable analysis, only increasing age, cardiac arrest, and existing lymphopenia remained significant admission risk factors (p < 0.05); whereas trauma tended to be related to nosocomial infection development (p = 0.07). Conclusions These data suggest that increasing age, cardiac arrest, and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients

“…B cell deficiency could also impair the bacterial clearance by decreasing the production of inflammatory cytokines and chemokines, which are needed for neutrophil activation [33]. The data from critically ill children have shown that lymphocytopenia predisposed long-stay paediatric ICU (PICU) patients without known baseline immunocompromise to nosocomial infection [34]. In a recent study focused on patients with shock in ICU, lymphocytopenia on admission was also found to increase the nosocomial infection, which partially supported our findings [35].…”

Occurrence of marked sepsis-induced immunosuppression in pediatric septic shock: a pilot study

“…Furthermore, secondary acquired infections represent a major economic burden by significantly extending length of hospital stay [ 41 , 42 ], and concordantly herein the length of hospitalization in those with secondary infection doubled (and this difference was significant). Taken together, these data reinforce the idea that most immunosuppressed septic children might benefit from immunostimulation as an adjunctive therapy [ 43 ].…”

Long-stay patients in pediatric intensive care units

“…Nosocomial infections are an important health problem even in children who stay more than 3 days in the PICU. Carcillo et al 18 found that increasing age, cardiac arrest, or lymphopenia predisposed long-stay PICU patients to nosocomial infections. Furthermore, it has been reported that resistant bacterial infections can result in significantly increased LOS in the ICU, which increases the economic burden of treating those patients and increases the load on health care providers.…”