What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study

Wang, Zaihua; Xia, Zhongfang

doi:10.1186/s13052-019-0769-9

Cited by 8 publications

(14 citation statements)

References 37 publications

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“…In the present study, the incidence of colonization of MDR bacteria among all admitted patients was 26/282 (9.2%) which was comparable to the incidence reported by a study done in three PICUs of one tertiary children’s hospital in Italy 8.72% (79/906) [ 11 ], which is significantly lower than that of older reports with incidence of MDROs that ranged from10 to 25% in PICU [ 12 , 13 ].…”

Section: Discussionsupporting

confidence: 78%

Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

Rezk

Bawady

Abdelghaffar

2021

Egypt Pediatric Association Gaz

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Background Healthcare-associated infections (HCAI) are a worldwide threat in intensive care units particularly in the pediatric intensive care units with a major cause of morbidity and mortality among this age group. The aim of the study is to determine the prevalence and risk factors predisposing to multidrug-resistant organisms (MDROs) infections among pediatric intensive care unit (PICU) patients at Ain Shams Pediatric University Hospitals as well as determining mortality and morbidity rates along with the length of stay at PICU. Results Culture results revealed that of the 282 patients evaluated, only 26 (9.2%) were MDROs (half of the affected patients had Acinetobacter species (50%) and the rest of them were free, 256 (90.8%). Our study revealed that the majority of MDROs were isolated from sputum in more than half of the patients 19/32 (59.3%) followed by whole blood in 10/32 (31.2%) and urine in 3/32 (9.4%). Pulmonary system was the most common affected site and was mainly colonized by MDR Acinetobacter (71.4%) followed by MDR Klebsiella (41.6%). Regarding MDR risk factors in our PICU, multivariate logistic regression analyses showed significant relationship between MDROs and age under 1 year (odds ratio [OR] 2.4554; 95% confidence interval [95% CI] (1.072–5.625); p = 0.043) and underlying pulmonary disease (OR 2.417; 95% CI (1.014–5.761); p = 0.592). A statistically significant higher mortality was detected in patients colonized with MDROs 9/26 (34.6%) versus MDROs non-colonized patients 32/256 (12.5%) [P=0.002]. Moreover, MDROs infection has negative significant risk with discharged patients ([OR] 0.269; [95% CI] (0.111–0.656); p = 0.002). Additionally, patients infected with MDROs did have significantly greater PICU stay than those non-infected [median (IQR), 16.5 (10.7–22), 5 (4–8), P=0.00] and have longer ventilation [median (IQR), 15.5 (10–18), 3 (2–10), P=0.00]. Conclusion Prevalence of MDROs (9.2%) was low among PICU cases at Ain Shams University Hospitals. Most common MDROs were Acinetobacter and Klebsiella followed by pseudomonas species. The frequency of gram-negative organisms is much more common than gram-positive organisms. An increasing rate of antimicrobial resistance with increasing mortality and morbidity among PICU patients is observed worldwide; even for new categories, so, strict infection control programs should be implemented.

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Section: Discussionsupporting

confidence: 78%

Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

Rezk

Bawady

Abdelghaffar

2021

Egypt Pediatric Association Gaz

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“…The hazard of getting HAIs among paediatric hospitalized patients staying in hospital more than 7 days was over 7 times higher than their counterparts. This nding is consistent to the current literature (3,11). The prolonged hospitalization stay increases the likelihood of acquiring HAIs, whereas the presence of HAIs also extends the hospitalization stay, which is a positive association (23).…”

Section: Discussionsupporting

confidence: 93%

“…The risk of acquiring HAIs in paediatric hospitalized patients who used more than 3 kinds of antibiotics were over 3 times higher than those using less than 3 kinds of antibiotics, which is consistent with the study conducted among paediatric hospitalized patients with multi-drug resistant infection in PICU (11). Multiple varieties of antibiotics applied in paediatric hospitalized patients change the children's physiology and biochemistry, leading to weakening the children's immune system to the bacteria (11,39). This can increase the risk of obtaining HAIs.…”

Section: Discussionsupporting

confidence: 89%

“…Our review also found that paediatric hospitalized patients with invasive procedure were over 5 times more hazardous to obtain HAIs than their counterparts. Many studies have reported that invasive procedure, such as surgery, mechanical ventilation, and central venous catheter and so on increased the risk of obtaining HAIs among paediatric hospitalized patients (11,38). The hazard of getting HAIs among paediatric hospitalized patients staying in hospital more than 7 days was over 7 times higher than their counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…A study undertaken in the developing countries showed that the incidence of HAIs in neonate intensive care (NICU) is nearly 30% and is responsible for 4-56% of all causes of reported neonatal deaths (9,10). Specially, the prevalence of HAIs was reported with a range from 10 to 25 % in paediatric intensive care (PICU) in China (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Healthcare-associated Infections Among Pediatric Hospitalized Patients in Chinese General Hospitals From 2001 to 2020: A Systematic Review and Meta-Analysis

Cao²,

Liu

et al. 2021

Preprint

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Background: Healthcare-associated infections (HAIs) have been an increasing global public health threat to the globe. Paediatric hospitalized patients are particularly to HAIs and the identification of risk factors is essential to help policy-makers and hospital managers to develop prevention and control strategies. This study aims to determine the risk factors associated with HAIs among paediatric hospitalized patients in Chinese general hospitals.Methods: Medline, EMBASE and Chinese Journals Online databases were searched. The search was limited to studies published from January 1st 2001 and December 31st 2020. Meta-analyses of OR in the prevalence were estimated. Heterogeneity between studies was assessed based on the B2 and I2 statistics to select the meta-analysis model. Reviewer Manager 5.3 was employed and P<0.05 was considered as the statistical significance.Results: 205 published articled were searched from the databases, in which 25 studies were included in the quantitative synthesis and meta-analysis for the risk factors of HAIs among paediatric hospitalized patients in Chinese general hospitals. 61,773 paediatric patients were incorporated in the included studies, which covered 13 regions in 10 provinces in China. Of them, 2,438 paediatric patients had HAIs. The meta-analyses showed that the ORs of younger age(2.25[1.32-3.85]), hormone(3.66[1.73-7.74]), invasive procedures(5.62[4.27-7.40]), longer hospitalization stay (7.79[6.38-9.50]), malnutrition(3.72,[1.80-7.70]), over 3 kinds of antibiotics (3.25,[2.66-3.96]), over 3 kinds of underlying disease (4.24[1.84-9.78]), large room (2.22[1.28-3.85)), and autumns and winter (1.56[1.04-2.35)) were the independent risk factors that had a negative impact on HAIs with a statistical significance (P<0.05).Conclusions: Under the age of 1 year, application of hormone, experiencing invasive procedure, hospitalization stay more than 7 days, malnutrition, using more than 3 kinds of antibiotics, beyond 3 kinds of underlying disease, large room, and autumn and winter were the main risk factors associated with the higher prevalence of HAIs among paediatric hospitalized patients in Chinese general hospitals. This provided the evidence base to inform the policy-makers and hospital managers. The confirmed successful and cost-effective prevention and control measures need to be adopted to reduce the occurrence of HAIs.

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Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units

Wu¹,

Lu²,

Ruan³

et al. 2023

IDR

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Objectives Multi-drug resistance (MDR) emerged as a serious threat in intensive care unit (ICU) settings. Our study aimed to investigate the major pathogens in ICU and identify the risk factors for MDR infection. Methods We performed a retrospective analysis of patients admitted to the ICU. Multivariate logistic regression was applied to identify the independent predictors, and then a nomogram to predict the probability of MDR infection. Results A total of 278 patients with 483 positive cultures were included. 249 (51.55%) had at least one MDR pathogen, including extensively drug-resistant (XDR) 77 (30.92%) and pan drug-resistant (PDR) 39 (15.66%), respectively. Klebsiella pneumonia was the most frequently isolated pathogen. We identified the number of bacteria (OR 2.91, 95% CI 1.97–4.29, P < 0.001), multiple invasive procedures (OR 2.23, 95% CI 1.37–3.63, P = 0.001), length of stay (LOS) (OR 1.01, 95% CI 1.00–1.02, P = 0.007), Hemoglobin (Hb) (OR 0.99, 95% CI 0.98–1.00, P = 0.01) were independent risk factors for MDR infection. Our nomogram displayed good discrimination with curve AUC was 0.75 (95% CI: 0.70–0.81). The decision curves also indicate the clinical utility of our nomogram. Additionally, the in-hospital mortality with MDR pathogens was independently associated with XDR (HR, 2.60; 95% CI: 1.08–6.25; P = 0.03) and total protein (TP) (HR, 0.95; 95% CI: 0.91–0.99; P = 0.03). Conclusion The number of bacteria, multiple invasive procedures, LOS, and Hb were the independent predictors associated with MDR pathogens. Our nomogram is potentially useful for predicting the occurrence of MDR infection. Besides, we also identify XDR and TP as the independent risk factors for in-hospital mortality with MDR infection. The current prevalence of MDR strains was also described. The results will contribute to the identification and preventive management of patients at increased risk of infection.

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What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study

Cited by 8 publications

References 37 publications

Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

Risk Factors of Healthcare-associated Infections Among Pediatric Hospitalized Patients in Chinese General Hospitals From 2001 to 2020: A Systematic Review and Meta-Analysis

Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units

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