Martins Cátia, Lima Daniela, Cortez Ferreira Mariana, Verdelho Andrade Joana, Dias Andrea
*Co-primeira autora; Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico. Unidade Local de Saúde de Coimbra. Coimbra. Portugal.
*Co-primeira autora; Clínica Universitária de Pediatria. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Acta Med Port. 2025 Jan 2;38(1):23-36. doi: 10.20344/amp.22279.
Healthcare-associated infections are an important cause of morbidity and mortality in the pediatric population and a growing problem in intensive care services. However, limited data are available on these infections in the Portuguese pediatric population. This study aimed to estimate its prevalence rate in a Portuguese pediatric intensive care unit, identifying the most frequent microorganisms and their antibiotic resistance profiles.
A retrospective cohort study was conducted, including patients admitted to a pediatric intensive care unit between January 1, 2014 and December 31, 2023, who were diagnosed with healthcare-associated infections during hospitalization.
A total of 248 nosocomial infections were identified, corresponding to a prevalence rate of 6.3%, mostly in infants. Pneumonia (45.2%) and bacteremia (14.5%) were the most frequent infections. Gram-negative bacteria, specifically Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, were the most common pathogens. Over the last five years (2019 - 2023), there was a global increase in antibiotic resistance. The prevalence of infections with ESBL-producing bacteria, MRSA and ERC was 8.5%, 1.6%, and 0.4%, respectively, higher in the period from 2019 to 2023. Among 97 screening tests, 45 colonizations were identified in 41 patients: 40 with ESBL and 5 with ERC, with no MRSA colonizations detected. Sepsis occurred in 29.8% of cases, and the mortality rate was 11.7%, with 4.0% directly attributed to healthcare-associated infections. Risk factors for pneumonia included exposure to endotracheal tubes and prolonged invasive ventilation (OR = 2.5; 95% CI, 1.1 to 5.9, p = 0.03; and OR = 1.9; 95% CI, 1.1 to 3.4, p = 0.011; respectively).
Implementing effective strategies to prevent and control resistant bacteria is essential to safeguard current therapies, enhance patient safety, and protect public health.
医疗保健相关感染是儿科人群发病和死亡的重要原因，也是重症监护服务中日益严重的问题。然而，关于葡萄牙儿科人群中这些感染的数据有限。本研究旨在估计葡萄牙一家儿科重症监护病房中其患病率，确定最常见的微生物及其抗生素耐药谱。
进行了一项回顾性队列研究，纳入2014年1月1日至2023年12月31日期间入住儿科重症监护病房且在住院期间被诊断为医疗保健相关感染的患者。
共识别出248例医院感染，患病率为6.3%，主要发生在婴儿中。肺炎（45.2%）和菌血症（14.5%）是最常见的感染。革兰氏阴性菌，特别是大肠杆菌、铜绿假单胞菌和肺炎克雷伯菌是最常见的病原体。在过去五年（2019 - 2023年），抗生素耐药性总体呈上升趋势。产超广谱β-内酰胺酶（ESBL）细菌、耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类肠杆菌科细菌（ERC）感染的患病率分别为8.5%、1.6%和0.4%，在2019年至2023年期间更高。在97次筛查测试中，在41名患者中识别出45例定植：40例为ESBL定植，5例为ERC定植，未检测到MRSA定植。29.8%的病例发生脓毒症，死亡率为11.7%，其中4.0%直接归因于医疗保健相关感染。肺炎的危险因素包括气管插管暴露和长时间有创通气（比值比分别为2.5；95%置信区间，1.1至5.9，p = 0.03；以及比值比为1.9；95%置信区间，1.1至3.4，p = 0.011）。
实施有效的预防和控制耐药菌策略对于保障当前治疗、提高患者安全和保护公众健康至关重要。
