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Effect of Nosocomial Infections Due to Antibiotic-Resistant Organisms on Length of Stay and Mortality in the Pediatric Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Elizabeth E. Foglia ,
Victoria J. Fraser  and
Alexis M. Elward
Elizabeth E. Foglia
Affiliation:
Departments of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
Alexis M. Elward*
Affiliation:
Departments of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
*
Department of Pediatric Infectious Diseases, St. Louis Children's Hospital, One Children's Place, Room 11W32, St. Louis, MO 63110 ([email protected])
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Abstract

Objective.

To determine the prevalence, risk factors, and outcomes of nosocomial infection due to antimicrobial resistant bacteria in patients treated in the pediatric intensive care unit (PICU).

Design.

Nested case-cohort study. Patient data were collected prospectively, and antimicrobial susceptibility data were abstracted retrospectively.

Setting.

A large pediatric teaching hospital.

Patients.

All PICU patients admitted from September 1, 1999, to September 1, 2001, unless they died within 24 hours after PICU admission, were 18 years old or older, or were neonatal intensive care unit patients receiving extracorporeal membrane oxygenation.

Results.

A total of 135 patients with more than 1 nosocomial bacterial infection were analyzed; 52% were male, 75% were white, the mean Pediatric Risk of Mortality score was 10.5, and the mean age was 3.5 years. Of these patients, 37 (27%) had nosocomial infections due to antibiotic-resistant organisms. In univariate analysis, transplantation (odds ratio [OR], 2.83 [95% confidence interval (CI), 1.05-7.66]) and preexisting lung disease (OR, 2.63 [95% CI, 1.18-5.88]) were associated with nosocomial infections due to antibiotic-resistant organisms. Age, Pediatric Risk of Mortality score at admission, length of hospital stay before infection, and other underlying conditions were not associated with infections due to antibiotic-resistant organisms. Patients infected with antibiotic-resistant organisms had greater mean PICU lengths of stay after infection, compared with patients infected with antibiotic-susceptible organisms (22.9 vs 12.8 days; P = .004), and higher crude mortality rates (OR, 2.40 [95% CI, 1.03-5.61]).

Conclusions.

Identifiable risk factors exist for nosocomial infections due to antibiotic-resistant organisms. In univariate analysis, infections due to antibiotic-resistant bacteria are associated with increased length of stay in the PICU after onset of infection and increased mortality.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 3 , March 2007 , pp. 299 - 306
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Centers for Disease Control and Prevention, National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
2.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google Scholar
3.Gerding, DN. Is there a relationship between vancomycin-resistant en-terococcal infection and Clostridium difficile infection? Clin Infect Dis 1997;25(Suppl 2):S206–S210.Google Scholar
4.Carmeli, Y, Troillet, N, Karchmer, AW, Samore, MH. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159:1127–1132.CrossRefGoogle ScholarPubMed
5. The Brooklyn Antibiotic Resistance Task Force. The cost of antibiotic resistance: effect of resistance among Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa on length of hospital stay. Infect Control Hosp Epidemiol 2002;23:106–108.Google Scholar
6.Raymond, DP, Pelletier, SJ, Crabtree, TD, Evans, HL, Pruett, TL, Sawyer, RG. Impact of antibiotic-resistant gram-negative bacilli infections on outcome in hospitalized patients. Crit Care Med 2003;31:1035–1041.Google Scholar
7.Vanhems, P, Lepape, A, Savey, A, Jambou, P, Fabry, J. Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival. J Hosp Infect 2000;45:98–106.CrossRefGoogle ScholarPubMed
8.Toltzis, P, Yamashita, T, Vilt, L, Blumer, JL. Colonization with antibiotic-resistant gram-negative organisms in a pediatric intensive care unit. Crir Care Med 1997;25:538–544.CrossRefGoogle Scholar
9.Toltzis, P, Hoyen, C, Spinner-Block, S, Salvator, AE, Rice, LB. Factors that predict preexisting colonization with antibiotic-resistant gram-negative bacilli in patients admitted to a pediatric intensive care unit. Pediatrics 1999;103:719–723.CrossRefGoogle ScholarPubMed
10.Pollack, MM, Patel, KM, Ruttimann, UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996;24:743–752.Google Scholar
11.Elward, AM, Warren, DK, Fraser, VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 2002;109:758–764.CrossRefGoogle ScholarPubMed
12.Yogaraj, JS, Elward, AM, Fraser, VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2002;110:481–485.CrossRefGoogle ScholarPubMed
13.Hill, A. The environment and disease: association or causation? Proc R Soc Med 1965;58:295–300.Google Scholar
14.Toltzis, P, Blumer, JL. Nosocomial acquisition and transmission of antibiotic-resistant gram-negative organisms in the pediatric intensive care unit. Pediatr Infect Dis J 2001;20:612–618.Google Scholar
15.Olson, B, Weinstein, RA, Nathan, C, Chamberlin, W, Kabins, SA. Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 1984; 150:808–816.CrossRefGoogle ScholarPubMed
16.Kim, BN, Woo, IH, Kim, MN, Ryu, J, Kim, YS. Clinical implications of extended-spectrum beta-lactamase-producing JC/ebsieWapnewmomaebac-teraemia. J Hosp Infect 2002;52:99–106.CrossRefGoogle Scholar
17.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
18.Diep, BA, Sensabaugh, GF, Somboona, NS, Carleton, HA, Perdreau-Remington, F. Widespread skin and soft-tissue infections due to two methicillin-resistant Staphylococcus aureus strains harboring the genes for Pan-ton-Valentine leucocidin. J Clin Microbiol 2004;42:2080–2084.Google Scholar
19.Dufour, P, Gillet, Y, Bes, M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002;35:819–824.CrossRefGoogle ScholarPubMed
20.Gillet, Y, Issartel, B, Vanhems, P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002;359:753–759.Google Scholar
21.Sechi, LA, Karadenizli, A, Deriu, A, et al. PER-1 type beta-lactamase production in Acinetobacter baumannii is related to cell adhesion. Med Sci Monit 2004;10:BR180–BR184.Google Scholar
22.Livrelli, V, De Champs, C, Di Martino, P, Darfeuille-Michaud, A, Forestier, C, Joly, B. Adhesive properties and antibiotic resistance of Klebsiella, Enterobacter, and Serratia clinical isolates involved in nosocomial infections. J Clin Microbiol 1996;34:1963–1969.Google Scholar
23.Di Martino, P, Gagniere, H, Berry, H, Bret, L. Antibiotic resistance and virulence properties of Pseudomonas aeruginosa strains from mechanically ventilated patients with pneumonia in intensive care units: comparison with imipenem-resistant extra-respiratory tract isolates from uninfected patients. Microbes Infect 2002;4:613–620.Google Scholar
24.Ramisse, F, van Delden, C, Gidenne, S, Cavallo, J, Hernandez, E. Decreased virulence of a strain of Pseudomonas aeruginosa 012 overexpressing a chromosomal type 1 beta-lactamase could be due to reduced expression of cell-to-cell signaling dependent virulence factors. FEMS Immunol Med Microbiol 2000;28:241–245.Google Scholar
25.Gray, JM, Gossain, SM, Morris, M. Three-year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 2001;20:416–421.Google Scholar
26.Armenian, SH, Singh, J, Arrieta, AC. Risk factors for mortality resulting from bloodstream infections in a pediatric intensive care unit. Pediatr Infect Dis J 2005;24:309–314.Google Scholar
27.Garrouste-Orgeas, M, Chevret, S, Mainardi, JL, Timsit, JF, Misset, B, Carlet, J. A one-year study of nosocomial bacteraemia in ICU and non-ICU patients and its impact on patient outcome. J Hosp Infect 2000;44:206–213.Google Scholar