Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length of Hospital Stay and Mortality Using a Multistate Analysis of Linked, Routinely Collected Data

Green, N.; Johnson, Alan P.; Henderson, Katherine L.; Müller‐Pebody, Berit; Thelwall, Simon; Robotham, Julie V.; Wolkewitz, Martin; Deeny, Sarah R

doi:10.1093/jpids/piu073

Cited by 23 publications

(36 citation statements)

References 32 publications

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“…The mean difference in estimated length of stay between transient states (depicted with 0 and 1.x notation in Figure 1) was calculated on each day (given that infection had or had not occurred by that day) and averaged across all days. This method for estimating transition probabilities is in line with previous studies utilising the multistate methodology to estimate infection-related, time-adjusted excess length of stay [12,14,24].…”

Section: (Ii) Length Of Staysupporting

confidence: 71%

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A National Estimate of the Health and Cost Burden ofEscherichia coliBacteraemia in the Hospital Setting: The Importance of Antibiotic Resistance

Naylor

Pouwels

Hope

et al. 2017

Preprint

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Background: Antibiotic resistance poses a threat to public health and a burden to healthcare systems. Escherichia coli causes more bacteraemia cases in England than any other bacterial species, these infections, in part due to their high incidence, also pose a significant antibiotic resistance burden. The main aim of this study was to estimate the impact of E. coli bacteraemia on patient inhospital mortality and length of stay. Secondarily, this study also aimed to estimate the effect of antibiotic resistance on these outcomes.

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Section: (Ii) Length Of Staysupporting

confidence: 71%

“…Using the above methodology allows for the computation of time-and covariate-adjusted estimation of independent variable impacts the daily risk of in-hospital mortality [12,24].…”

Section: (I) In-hospital Mortalitymentioning

confidence: 99%

A National Estimate of the Health and Cost Burden ofEscherichia coliBacteraemia in the Hospital Setting: The Importance of Antibiotic Resistance

Naylor

Pouwels

Hope

et al. 2017

Preprint

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“…Other approaches, including multistate regression analysis, could be adopted to investigate multiple events associated with HAI, such as excess length of hospital stay and mortality. 28 Our multicenter study was conducted in 2 countries; differences in population demographic characteristics, organization of care, and laboratory techniques for confirming HAIs and diagnosing MDR may have influenced our results. Further studies should be conducted in multiple countries to better address geographical variability.…”

Section: Discussionmentioning

confidence: 97%

Healthcare-Associated Infections in Pediatric and Neonatal Intensive Care Units: Impact of Underlying Risk Factors and Antimicrobial Resistance on 30-Day Case-Fatality in Italy and Brazil

Folgori

Bernaschi

Piga

et al. 2016

Infect. Control Hosp. Epidemiol.

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objectives. To describe trends in the epidemiology of healthcare-associated Infections (HAIs) in pediatric/neonatal intensive care units (ICUs) and to evaluate risk factors and impact of multidrug resistance in children admitted to ICUs.design. Multicenter, retrospective, cohort study with a nested case-control study conducted from January 1, 2010, through December 31, 2014.setting. Three tertiary care pediatric hospitals in Italy and Brazil with a total of 103 ICU beds.patients. Inclusion criteria were admission to ICU during the study period, age at onset less than 18 years, and microbiologically confirmed HAI.results. A total of 538 HAIs in 454 children were included; 93.3% of patients had comorbidities. Bloodstream infections were the leading pattern (45.4%). The cumulative incidence of HAI was 3.6/100 ICU admissions and the crude 30-day fatality rate was 5.7/1,000 admissions. The most frequently isolated pathogens were Enterobacteriaceae, followed by Pseudomonas aeruginosa and Staphylococcus aureus. Forty-four percent of isolates were multidrug-resistant (MDR). Two multivariate logistic regressions were performed. Factors independently associated with an MDR-HAI were country, previous antibiotics, transplantation, major surgery, and colonization by an MDR strain. Factors independently associated with 30-day case fatality were country, previous transplantation, fungal infection, bloodstream infection, lower respiratory tract infection, and infection caused by MDR strains.conclusions. Infection control and prevention can limit the spread of MDR strains and improve outcomes. Targeted surveillance programs collecting neonatal and pediatric HAI/bloodstream infection data and outcomes would allow global benchmarking. The next step is to identify methods to monitor key HAIs and integrate these into affordable intervention programs. 2016;37:1302-1309 Healthcare-associated infections (HAIs) are one of the most frequent adverse events affecting children admitted to intensive care units (ICUs). Infect Control Hosp Epidemiol1,2 Exposure to invasive devices and procedures, immune suppression, and underlying conditions are considered as main determinants of patients' increased susceptibility.3,4 The impact of multidrug-resistant (MDR) organisms in pediatrics is increasing globally. [5][6][7] It is assumed that infections caused by MDR bacteria will have a worse prognosis because of the delay in the administration of appropriate therapy. However, it is difficult to estimate the clinical impact of MDR-HAI in children.Previous literature has shown conflicting results about the impact of different underlying risk factors on the clinical outcome of patients with HAI admitted to ICUs. There is no clear independent correlation between antimicrobial resistance and patients' mortality. [8][9][10][11] Clarifying the relationship between patient risk factors and pediatric HAI mortality could allow improved targeting of interventions on the patients most at risk of adverse outcome. The aims of this study were to describe trends i...

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“…It also provided important insight into the pathogens associated with hospital-acquired infections and their susceptibility to recommended first-line antibiotics. A subsequent study using the same linked dataset quantified the increased length of stay and excess mortality associated with hospital-acquired bacteraemia [87]. A complementary approach involving linkage of LabBase2 data with clinical and demographic data from PICANet has also been used for monitoring of risk-adjusted bacteraemia trends in paediatric intensive care [89].…”

Section: Current and Future Developments In Surveillance (A) Data Linmentioning

confidence: 99%

Surveillance of antibiotic resistance

Johnson

2015

Phil. Trans. R. Soc. B

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Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform as to the epidemiology of the threat and its burden in the population. A further key component of surveillance is the timely feedback of data to stakeholders with a view to generating action aimed at reducing or preventing the public health threat being monitored. Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility test results undertaken by microbiology laboratories on bacteria isolated from clinical samples sent for investigation. Correlation of these data with demographic and clinical data for the patient populations from whom the pathogens were isolated gives insight into the underlying epidemiology and facilitates the formulation of rational interventions aimed at reducing the burden of resistance. This article describes a range of surveillance activities that have been undertaken in the UK over a number of years, together with current interventions being implemented. These activities are not only of national importance but form part of the international response to the global threat posed by antibiotic resistance.

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Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length of Hospital Stay and Mortality Using a Multistate Analysis of Linked, Routinely Collected Data

Abstract: Hospital-acquired bloodstream infection increased the length of stay and mortality of pediatric inpatients. The results of this study provide an evidence base to judge the health and economic impact of programs to prevent and control HA-BSI in children.

Cited by 23 publications

References 32 publications

A National Estimate of the Health and Cost Burden ofEscherichia coliBacteraemia in the Hospital Setting: The Importance of Antibiotic Resistance

A National Estimate of the Health and Cost Burden ofEscherichia coliBacteraemia in the Hospital Setting: The Importance of Antibiotic Resistance

Healthcare-Associated Infections in Pediatric and Neonatal Intensive Care Units: Impact of Underlying Risk Factors and Antimicrobial Resistance on 30-Day Case-Fatality in Italy and Brazil

Surveillance of antibiotic resistance

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