Browse > Article

Pattern of Hospital-Associated Infections in Children Admitted in the Intensive Care Unit of a University Hospital  

Kim, Su Nam (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Won, Chong Bock (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Cho, Hye Jung (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Eun, Byung Wook (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Sim, So Yeon (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Choi, Deok Young (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Sun, Yong Han (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Cho, Kang Ho (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Son, Dong Woo (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Tchah, Hann (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Jeon, In Sang (Department of Pediatrics, Graduate School of Medicine, Gachon University)
Publication Information
Pediatric Infection and Vaccine / v.18, no.2, 2011 , pp. 135-142 More about this Journal
Abstract
Purpose : Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. Methods : We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. Results : In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patientdays. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. Conclusion : ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.
Keywords
Multidrug-resistant; Hospital-associated infection; Intensive care unit; Risk factor;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003;29:1482-8.   DOI   ScienceOn
2 L'Heriteau F, Alberti C, Cohen Y, Troche G, Moine P, Timsit JF. Nosocomial infection and multidrug-resistant bacteria surveillance in intensive care units: a survey in France. Infect Control Hosp Epidemiol 2005;26:13-20.   DOI   ScienceOn
3 Luzzati R, Antozzi L, Bellocco R, Del Bravo P, Mirandola M, Procaccio F, et al. Prevalence of nosocomial infections in intensive care units in Triveneto area, Italy. Minerva Anestesiol 2001;67:647-52.
4 Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-44.   DOI   ScienceOn
5 Zhanel GG, DeCorby M, Laing N, Weshnoweski B, Vashisht R, Tailor F, et al. Antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) study, 2005-2006. Antimicrob Agents Chemother 2008;52:1430-7.   DOI   ScienceOn
6 Mireya UA, Marti PO, Xavier KV, Cristina LO, Miguel MM, Magda CM. Nosocomial infections in paediatric and neonatal intensive care units. J Infect 2007;54:212-20.   DOI   ScienceOn
7 Mayhall CG. Hospital epidemiology and infection control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
8 Sritippayawan S, Sri-Singh K, Prapphal N, Samransamruajkit R, Deerojanawong J. Multidrug-resistant hospital-associated infections in a pediatric intensive care unit: a cross-sectional survey in a Thai university hospital. Int J Infect Dis 2009;13:506-12.   DOI   ScienceOn
9 Ortega B, Groeneveld AB, Schultsz C. Endemic multidrugresistant Pseudomonas aeruginosa in critically ill patients. Infect Control Hosp Epidemiol 2004;25:825-31.   DOI   ScienceOn
10 Singh-Naz N, Sprague BM, Patel KM, Pollack MM. Risk factors for nosocomial infection in critically ill children: a prospective cohort study. Crit Care Med 1996;24:875-8.   DOI   ScienceOn
11 Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-9.   DOI   ScienceOn
12 Jeena P, Thompson E, Nchabeleng M, Sturm A. Emergence of multidrug-resistant Acinetobacter anitratus species in neonatal and pediatric intensive care units in a developing country: concern about antimicrobial policies. Ann Trop Paediatr 2001;21:245-51.   DOI   ScienceOn
13 Patra PK, Jayashree M, Singhi S, Ray P, Saxena AK. Nosocomial pneumonia in a pediatric intensive care unit. Indian Pediatr 2007;44:511-8.
14 Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2007;51:3471-84.   DOI   ScienceOn
15 Katragkou A, Kotsiou M, Antachopoulos C, Benos A, Sofianou D, Tamiolaki M, et al. Acquisition of imipenemresistant Acinetobacter baumannii in a pediatric intensive care unit: A case-control study. Intensive Care Med 2006;32:1384-91.   DOI   ScienceOn
16 Bergogne-Berezin E. The increasing significance of outbreaks of Acinetobacter spp.: the need for control and new agents. J Hosp Infect 1995;30 Suppl:441-52.   DOI
17 Gerner-Smidt P. Taxonomy and epidemiology of Acinetobacter infections. Rev Med Microbiol 1995;6:186-97.
18 Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.   DOI   ScienceOn
19 Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jimenez-Jimenez FJ, Monterrubio-Villar J, Gili-Miner M. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med 1999;27:1794-9.   DOI   ScienceOn
20 Kuo LC, Yu CJ, Lee LN, Wang JL, Wang HC, Hsueh PR, et al. Clinical features of pandrug-resistant Acinetobacter baumannii bacteremia at a university hospital in Taiwan. J Formos Med Assoc 2003;102:601-6.
21 Gupta A, Agrawal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian J Crit Care Med 2011;15:96-101.   DOI   ScienceOn
22 Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics 2009;123:1108-15.   DOI   ScienceOn
23 D'Agata EM. Rapidly rising prevalence of nosocomial multidrug-resistant, gram-negative bacilli: a 9-year surveillance study. Infect Control Hosp Epidemiol 2004;25:842-6.   DOI   ScienceOn
24 Levy SS, Mello MJ, Gusmao-Filho FA, Correia JB. Colonisation by extended-spectrum beta-lactamase-producing Klebsiella spp. in a paediatric intensive care unit. J Hosp Infect 2010;76:66-9.   DOI   ScienceOn
25 Asensio A, Oliver A, Gonzalez-Diego P, Baquero F, Perez-Diaz JC, Ros P, et al. Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection. Clin Infect Dis 2000;30:55-60.   DOI   ScienceOn
26 Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531-9.   DOI   ScienceOn
27 Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK, et al. Risk factors for an outbreak of multidrug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999;115:1378-82.   DOI   ScienceOn
28 Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 2003;35:843-50.   DOI   ScienceOn
29 Lucet JC, Chevret S, Decre D, Vanjak D, Macrez A, Bedos JP, et al. Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430-6.   DOI   ScienceOn
30 Eggimann P, Pittet D. Infection control in the ICU. Chest 2001;120:2059-93.   DOI   ScienceOn
31 Weber DJ, Raasch R, Rutala WA. Nosocomial infections in the ICU: the growing importance of antibiotic-resistant pathogens. Chest 1999;115:34S-41S.   DOI   ScienceOn
32 Kim KM, Yoo JH, Choi JH, Park ES, Kim KS, Kim KS, et al. The nationwide sunveillance results of nosocomial infections along with antimicrobial resistance in intensive care units of sixteen university hospitals in Korea, 2004. Korean J Nosocomial Infect Control 2006;2:79-86.