Gupta Ayush, Kapil Arti, Kabra S K, Lodha Rakesh, Sood Seema, Dhawan Benu, Das Bimal K, Sreenivas V
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2013 Dec;138(6):944-9.
BACKGROUND & OBJECTIVES: Healthcare associated infections (HAIs) are responsible for morbidity and mortality among immunocompromised and critically ill patients. We undertook this study to estimate the burden of HAIs in the paediatric cancer patients in a tertiary care hospital in north India.
This prospective, observational study, based on active surveillance for a period of 11 months was undertaken in a 4-bedded isolated, cubicle for paediatric cancer patients. Patients who stayed in the cubicle for ≥48 h, were followed prospectively for the development of HAIs.
Of the 138 patients, 13 developed 14 episodes of HAIs during the study period. Patient-days calculated were 1273 days. Crude infection rate (CIR) and incidence density (ID) of all HAIs were 9.4/100 patients and 11/1000 patient-days, respectively. Of the 14 episodes of HAIs, seven (50%) were of blood stream infections (HA-BSI), five (36%) of pneumonia (HAP) and two (14%) urinary tract infections (HA-UTI). The CIRs of HA-BSI, HAP and HA-UTI were 5.1, 3.6 and 1.4/100 patients, respectively. The corresponding IDs were 5.5, 3.9 and 1.6/1000 patient-days, respectively. Mean length of stay was significantly higher in patients who developed an HAI [13.8 (range 7-30), median (Interquartile range) 12 (11-14)] vs 7.5 days [range 2-28, median (interquartile range) 7 (5-9); P<0.0001]. Also mortality was significantly higher in patients who developed an HAI [23% (3/13) vs 3% (4/125), P<0.05].
INTERPRETATION & CONCLUSIONS: The incidence of HAIs in the paediatric cancer patients in the study was 11/1000 patient days, of which HA-BSIs were the commonest. HAIs were associated with an increase in morbidity and mortality amongst this high risk patient population.
医疗保健相关感染（HAIs）是免疫功能低下和重症患者发病和死亡的原因。我们开展这项研究以评估印度北部一家三级护理医院中儿科癌症患者的HAIs负担。
这项前瞻性观察性研究在一个有4张床位的儿科癌症患者隔离单间内进行，为期11个月，通过主动监测开展。在单间内停留≥48小时的患者被前瞻性地跟踪HAIs的发生情况。
在138名患者中，13名患者在研究期间发生了14次HAIs。计算得出的患者住院天数为1273天。所有HAIs的粗感染率（CIR）和发病密度（ID）分别为9.4/100患者和11/1000患者住院日。在14次HAIs中，7次（50%）为血流感染（HA-BSI），5次（36%）为肺炎（HAP），2次（14%）为尿路感染（HA-UTI）。HA-BSI、HAP和HA-UTI的CIR分别为5.1、3.6和1.4/100患者。相应的ID分别为5.5、3.9和1.6/1000患者住院日。发生HAI的患者平均住院时间显著更长[13.8（范围7 - 30），中位数（四分位间距）12（11 - 14）]，而未发生HAI的患者为7.5天[范围2 - 28，中位数（四分位间距）7（5 - 9）；P<0.0001]。发生HAI的患者死亡率也显著更高[23%（3/13）对3%（4/125），P<0.05]。
该研究中儿科癌症患者的HAIs发病率为11/1000患者住院日，其中HA-BSI最为常见。HAIs与这一高风险患者群体的发病率和死亡率增加相关。
