Nosocomial Infections in the Pediatric Intensive Care Unit: Epidemiology and Control

Lacroix, Jacques; Skippen, Peter; Cox, Peter N.; Langley, Joanne M.; Matlow, Anne

doi:10.1016/b978-032301808-1.50093-6

Cited by 5 publications

(9 citation statements)

References 259 publications

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“…Also, the HAI definitions used in the TRIPICU study followed the CDC 1988 definitions, and some were modified to include the presence of positive bacterial cultures. 26,27 The use of laboratory-confirmed HAI definitions aligns well with the current HAI definitions proposed by the CDC. 28 Another strength of our study is the use of a 'golden' period as the comparison group.…”

Section: Discussionmentioning

confidence: 66%

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Association between the length of storage of transfused leukoreduced red blood cell units and hospital‐acquired infections in critically ill children: A secondary analysis of the TRIPICU study

Flatman

Fergusson

Lacroix

et al. 2021

Transfusion Medicine

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Objective: Evaluate the association between leukoreduced red blood cell (RBC) storage length and hospital-acquired infection (HAI) incidence rate in critically ill children.Background: RBC transfusions are common in critically ill children. Despite their benefits, observational studies suggest an association between them and HAIs. One possible mechanism for increased HAI is transfusion-related immunomodulation due to bioactive substances' release as transfused blood ages. Methods: In this secondary analysis of the 'Transfusion Requirement in PaediatricIntensive Care Units' (TRIPICU) study, we analysed a subset of 257 participants that received only one pre-storage leukoreduced RBC transfusion. RBC storage length was classified as 1) transfusion of 'fresh' RBCs (≤10 days), 2) transfusion of 'stored' RBCs (21-34 days), and 3) transfusion of 'long-stored' RBCs (≥35 days). All were compared to a 'golden' period (11-20 days), representing the time between 'fresh' and 'stored'. We used quasi-Poisson multivariable regression models to estimate the HAI incidence rate ratio (IRR) and corresponding 95% confidence interval (CI).Results: We found that the association between the length of storage time of leukoreduced RBCs and HAIs was not significant in the 'fresh' group (IRR 1.23; 95% CI 0.55, 2.78) and the 'stored' group (IRR 1.61; 95% CI 0.63, 4.13) when compared to the 'golden' period. However, we observed a statistically significant association between the 'longstored' group and an increase in the HAI incidence rate (IRR 3.66; 95% CI 1.22, 10.98). Conclusion:Transfusion of leukoreduced RBC units stored for ≥35 days is associated with increased HAI incidence rate in haemodynamically stable, critically ill children. K E Y W O R D S critically ill children, hospital-acquired infections, leukoreduction, length of storage, red blood cell transfusion, secondary analysis 1 | INTRODUCTION Red blood cell (RBC) transfusions are a standard supportive measure for critically ill children. It is estimated that 49% of children admitted to 30 North American Paediatric Intensive Care Units (PICU) received at least one RBC transfusion during their admission. 1 Transfusing RBCs in critically ill patients is primarily performed to increase low haemoglobin levels and oxygen delivery to better support

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Section: Discussionmentioning

confidence: 66%

“…26 However, to increase the specificity of CLABSI and CAUTI, the research team used a modified definition that required the presence of positive bacterial cultures. 27 Importantly, these definitions are very similar to the CLABSI and CAUTI definitions currently recommended by CDC in 2020. 28…”

Section: Discussionmentioning

confidence: 82%

Association between the length of storage of transfused leukoreduced red blood cell units and hospital‐acquired infections in critically ill children: A secondary analysis of the TRIPICU study

Flatman

Fergusson

Lacroix

et al. 2021

Transfusion Medicine

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“…This was most probably due to a significant decrease in the nosocomial infections, because we could not record any other major changes in infection control and antibiotic prescribing practices during 2007 to 2008. Understaffing, close contact between patients and parents and crowding were found as major facilitators for nosocomial infection development in PICU 10 . Ben-Abraham et al 23 examined the effect of use of individual rooms on prevention of nosocomial infections and compared retrospective data from 1992 (when the PICU worked as an open single-space unit) with prospective surveillance from 1995 (when PICU moved to individual rooms).…”

Section: Discussionmentioning

confidence: 96%

“…While Gram-positive organisms represent the most frequently isolated pathogens, the problem of increasing antibiotic resistance of Enterobacteriaceae spp. in the PICU is worrying 7,10,14,16,17 . Furthermore, fungal BSIs are recorded with increasing frequency, reaching around 20% of all PICU BSI 10,14 .…”

Section: Impact Of Conversion From An Open Ward Design Paediatricmentioning

confidence: 99%

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Impact of Conversion from an Open Ward Design Paediatric Intensive Care Unit Environment to All Isolated Rooms Environment on Incidence of Bloodstream Infections and Antibiotic Resistance in Southern Israel (2000 to 2008)

Lazar

Abu-Kaf²,

Sofer

et al. 2015

Anaesth Intensive Care

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We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary paediatric intensive care unit. All BSI episodes were prospectively identified and analysed. The paediatric intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. Three hundred and fifty-three BSI episodes occurred in 299 of 4162 patients. Overall, BSI incidence was 85 per 1000 hospitalised children. Fewer BSI episodes occurred during the last two years of the study

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Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients

Spinella

Tucci

Fergusson

et al. 2019

JAMA

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IMPORTANCE The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial.OBJECTIVE To determine if the transfusion of fresh red blood cells (stored Յ7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. DESIGN, SETTING, AND PARTICIPANTSThe Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded.INTERVENTIONS Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. MAIN OUTCOMES AND MEASURESThe primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death.RESULTS Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34).CONCLUSIONS AND RELEVANCE Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells.

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Nosocomial Infections in the Pediatric Intensive Care Unit: Epidemiology and Control

Cited by 5 publications

References 259 publications

Association between the length of storage of transfused leukoreduced red blood cell units and hospital‐acquired infections in critically ill children: A secondary analysis of the TRIPICU study

Association between the length of storage of transfused leukoreduced red blood cell units and hospital‐acquired infections in critically ill children: A secondary analysis of the TRIPICU study

Impact of Conversion from an Open Ward Design Paediatric Intensive Care Unit Environment to All Isolated Rooms Environment on Incidence of Bloodstream Infections and Antibiotic Resistance in Southern Israel (2000 to 2008)

Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients

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