From the PICU, University Hospital, Medical School, University of Crete, Heraklion, Greece.
PICU, Agia Sofia Children's Hospital, Athens, Greece.
Pediatr Infect Dis J. 2021 Mar 1;40(3):231-237. doi: 10.1097/INF.0000000000002960.
Surveillance is essential to all aspects of management of healthcare-associated infections (HAIs) in critically ill children, where data are limited. We conducted an active surveillance study to elucidate epidemiology, resistance, antimicrobial treatment practices and outcomes of pediatric intensive care unit-acquired HAIs in a southern European country.
Four Greek pediatric intensive care unit encounters (153 patients, 2183 patient-days) during a 6-month period participated using the European Centre for Disease Prevention and Control HAI-net ICU (v2.2) protocol. Bloodstream infections and device-associated HAIs were recorded. Clinical severity, isolated pathogens, antimicrobial resistance and antibiotic prescriptions were collected on a daily basis. Mortality and excess length of stay due to HAI were also assessed.
Overall rate of HAIs was 18.3 per 1000 patient-days. Aggregate rates for device-associated HAI were: catheter-related bloodstream infection 2.32, intubation-associated pneumonia 10.5, and catheter-associated urinary tract infection 4.6 per 1000 device-days. Children with HAI (n = 28, 18.3%) had higher severity of illness (Pediatric Risk Mortality Score 7.5 vs. 4, P < 0.001), longer hospitalization (23 vs. 6 days, P < 0.001), but not higher mortality, compared with those without. Most frequent recovered pathogens were Klebsiella pneumoniae (40%), Pseudomonas aeruginosa (22.5%), Acinetobacter baumannii (12.5%), with respective carbapenem resistance 50%, 44% and 80%, and Staphylococcus aureus (12.5%). Total antibiotic use was 2142 days of treatment per 1000 patient-days.
Our study, based on the updated ECDC HAI-net ICU (v2.2) protocol, effectively addresses the significant burden of HAIs in critically ill children in Greece. Using a well-standardized system facilitates inter- and intra-countries reliable recordings and comparative assessments of infection control programs.
在重症监护病房（ICU）中，对医疗保健相关性感染（HAI）进行监测对于感染管理的各个方面都是至关重要的，而儿童 ICU 中的相关数据有限。我们在一个南欧国家进行了一项主动监测研究，以阐明流行病学、耐药性、抗菌药物治疗实践和儿科 ICU 获得性 HAI 的结局。
在 6 个月的时间里，4 家希腊儿科 ICU 共 153 例患者（2183 例患者日）参与了研究，使用了欧洲疾病预防控制中心 HAI-net ICU（v2.2）方案。记录血流感染和器械相关的 HAI。每天收集临床严重程度、分离病原体、抗菌药物耐药性和抗生素处方。还评估了 HAI 导致的死亡率和住院时间延长。
HAI 的总发生率为每 1000 个患者日 18.3 例。器械相关 HAI 的总发生率为：导管相关血流感染 2.32 例/1000 导管日，气管插管相关肺炎 10.5 例/1000 气管插管日，导管相关尿路感染 4.6 例/1000 导管日。发生 HAI 的患儿（n=28，18.3%）的疾病严重程度更高（儿科危重病评分 7.5 分 vs. 4 分，P<0.001），住院时间更长（23 天 vs. 6 天，P<0.001），但死亡率无差异。最常分离出的病原体是肺炎克雷伯菌（40%）、铜绿假单胞菌（22.5%）、鲍曼不动杆菌（12.5%），相应的碳青霉烯类耐药率分别为 50%、44%和 80%，金黄色葡萄球菌（12.5%）。抗生素总使用时间为每 1000 患者日 2142 天。
我们的研究基于最新的 ECDC HAI-net ICU（v2.2）方案，有效评估了希腊重症监护病房中儿童 HAI 的负担。使用标准化程度较高的系统有利于各国之间可靠地记录和比较感染控制方案。
