Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-10T22:37:26.810Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Published online by Cambridge University Press:  21 June 2016

Alexis M. Elward  and
Victoria J. Fraser
Alexis M. Elward*
Affiliation:
Departments of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Room 11W32, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

The primary objective was to determine the rate of and risk factors for nosocomial primary bloodstream infection (BSI) in pediatric intensive care unit (PICU) patients in order to determine the validity of our previously published findings. The secondary objective was to analyze whether risk factors for primary BSI differed by organism type, particularly whether device use was more strongly associated with BSI due to gram-positive organisms.

Design.

Prospective cohort study.

Settings.

St. Louis Children's Hospital, a 235-bed academic tertiary care center with a 28-bed combined medical and surgical PICU.

Patients.

PICU patients admitted between September 1, 1999, and September 1, 2001.

Outcome Measures.

Nosocomial primary BSIs.

Results.

Of 2,310 patients, 55% were male, and 73% were white. There were 124 episodes of primary BSI in 87 patients (3.8%). Coagulase-negative Staphylococcus organisms were the leading cause of BSI (42 of 124 episodes). The rate of BSI was 9 BSIs/1,000 central venous catheter–days. Multiple logistic regression analysis showed that independent predictors of nosocomial primary BSI included higher number of arterial catheter–days (adjusted odds ratio [aOR], 5.7 per day of arterial catheterization; 95% confidence interval [CI], 3.4-9.8), higher number of packed red blood cell transfusions (aOR, 1.2; 95% CI, 1.1-1.4), and genetic syndrome (aOR, 4.7; 95% CI, 1.8-12). Severity of illness, underlying illnesses, and medications were not independently associated with increased risk of nosocomial BSI.

Conclusion.

Arterial catheter use and packed red blood cell transfusion are potentially modifiable risk factors for nosocomial primary BSI in PICU patients. Genetic syndromes may be markers for unrecognized immune defects that impair host defense against microorganisms.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 6 , June 2006 , pp. 553 - 560
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Milliken, J, Tait, GA, Ford-Jones, EL, et al. Nosocomial infections in a pediatric intensive care unit. Crit Care Med 1988; 16:233–237.Google Scholar
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in the pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1999; 103:e39.CrossRefGoogle ScholarPubMed
3.Grohskopf, LA, Sinkowitz-Cochran, RL, Garrett, DO, et al. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 2002; 140:432–438.Google Scholar
4.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.Google Scholar
5.Pierce, CM, Wade, A, Mok, Q. Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 2000; 26:967–972.CrossRefGoogle ScholarPubMed
6.Gray, J, Gossain, S, Morno, K. Three-year survey of bacteremias and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 2001; 20:416–421.CrossRefGoogle Scholar
7.Stover, BH, Shulman, ST, Bratcher, DF, Brady, MT, Levine, GL, Jarvis, WR. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001; 29:152–157.Google Scholar
8.Urrea, M, Pons, M, Serra, M, Latorre, C, Palomeque, A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003; 22:490–494.CrossRefGoogle Scholar
9.The Centers for Disease Control and Prevention. Monitoring hospital-acquired infections to promote patient safety-United States, 1990-1999. MMWR Morb Mortal Wkly Rep 2000; 49:149–153 [published correction appears in MMWR Morb Mortal Wkly Rep 2000; 49:189-190].Google Scholar
10.Raymond, J, Aujard, Y. Nosocomial infections in pediatric patients: a European Multicenter Prospective Study. European Study Group. Infect Control Hosp Epidemiol 2000; 21:260–263.CrossRefGoogle ScholarPubMed
11.Slonim, AD, Kurtines, HC, Sprague, BM, Singh, N. The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2001; 2:170–174.Google Scholar
12.Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. The attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005; 115:868–872.CrossRefGoogle ScholarPubMed
13.Dominguez, TE, Chalom, R, Costarino, AT. The impact of adverse patient occurrences on hospital costs in the pediatric intensive care unit. Crit Care Med 2001; 29:169–174.Google Scholar
14.Odetola, FO, Moler, FW, Dechert, RE, VanDerElzen, K, Chenoweth, C. Nosocomial catheter-related bloodstream infection in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003; 4:432–436.CrossRefGoogle Scholar
15.Sing-Naz, N, Sprague, BM, Patel, KM, Pollack, M. Risk factors for nosocomial infection in critically ill children: a prospective cohort study. Crit Care Med 1996; 24:875–878.CrossRefGoogle Scholar
16.Pollack, MM, Patel, KM, Ruttimann, UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24:743–752.Google Scholar
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definition for nosocomial infections. In: Olmsted, RN, ed. Infection Control and Applied Epidemiology: Principle and Practice. St. Louis: Mosby; 1996:A1–A20.Google Scholar
18.Lorente, L, Villegas, J, Martin, M, Jimenez, A, Mora, M. Catheter-related infection in critically ill patients. Intensive Care Med 2004; 30:1681–1684.Google Scholar
19.Rijnders, B, Van Wijngaerden, E, Wilmer, A, Peetermans, W. Use of full sterile barrier precautions during insertion of arterial catheters: a randomized trial. Clin Infect Dis 2003; 36:743–748.Google Scholar
20.Frezza, E, Mezghebe, H. Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients. Am Surg 1998; 64:127–131.Google Scholar
21.Furfaro, S, Gauthier, M, Lacroix, J, Nadeau, D, Lafleur, L, Mathews, S. Arterial catheter–related infections in children. Am J Dis Child 1991; 145:1037–1042.Google Scholar
22.Ducharme, F, Gauthier, M, Lacroix, J, Lafleur, L. Incidence of infection related to arterial catheterization in children: a prospective study. Crit Care Med 1988; 16:272–276.Google Scholar
23.Niaudet, P, Dudley, J, Charbit, M, Gagnadoux, MF, Macleay, K, Broyer, M. Pretransplant blood transfusions with cyclosporine in pediatric renal transplantation. Pediatr Nephrol 2000; 14:451–456.Google Scholar
24.Opelz, G, Sengar, DP, Mickey, MR, Terasaki, PI. Effect of blood transfusions on subsequent kidney transplantations. Transplant Proc 1973; 5:253–259.Google Scholar
25.Van Es, AA, Balner, H. Effect of pretransplant transfusions on kidney allograft survival. Transplant Proc 1972; 14:608–617.Google Scholar
26.Opelz, G, Terasaki, PI. Improvement of kidney graft survival with increased numbers of blood transfusions. N Engl J Med 1978; 299:799–803.Google Scholar
27.Opelz, G, Varenterghem, Y, Kirste, G, et al. Prospective evaluation of pretransplant blood transfusions in cadaver kidney recipients. Transplantation 1997; 63:964–967.CrossRefGoogle ScholarPubMed
28.Park, J, Cho, K, Johnson, J, Perez, R. Induction of MIP-1 alpha in Kupffer cell by portal venous transfusion. Transplant Immunology 2004; 13:33–38.CrossRefGoogle Scholar
29.Jensen, LS, Andersen, AJ, Christiansen, PM, et al. Postoperative infection and natural killer cell function following blood transfusion inpatients undergoing elective colorectal surgery. Br J Surg 1992; 79:513–516.CrossRefGoogle Scholar
30.Mira, JP, Cariou, A, Grall, F, et al. Association of TNF2, a TNF alpha promoter polymorphism, with septic shock susceptibility and mortality: a multicenter study. JAMA 1999; 282:561–568.Google Scholar
31.Arbour, NC, Lorenz, E, Schutte, BC, et al. TLR4 mutations are associated with endotoxin hyporesponsiveness in humans. Nat Genet 2000; 25:187–191.Google Scholar
32.O'Keefe, GE, Hybki, D, Munford, RS. The G to A single nucleotide polymorphism at the —308 position in the tumor necrosis factor alpha promoter increases the risk for severe sepsis after trauma. J Trauma 2002; 52:817–826.Google Scholar
33.Majetschak, M, Flobe, S, Obertacke, U, et al. Relation of TNF gene polymorphism to severe sepsis in trauma patients. Ann Surg 1999; 230:207–214.Google Scholar
34.Gemke, RJ, Bonsel, GJ, van Vught, AJ. Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the Pediatric Risk of Mortality score. Crit Care Med 1994; 22:1477–1484.CrossRefGoogle ScholarPubMed
35.van Keulen, JG, Gemke, RJ, Polderamn, KH. Effect of training and strict guidelines on the reliability of risk adjustment systems in paediatric intensive care. Intensive Care Med 2005; 31:1229–1234.CrossRefGoogle ScholarPubMed