Jeffrey A Alten1, A K M Fazlur Rahman2, Hayden J Zaccagni3, Andrew Shin4, David S Cooper1, Joshua J Blinder5, Lauren Retzloff6, Inmaculada B Aban2, Eric M Graham7, Jeffrey Zampi8, Yuliya Domnina9, Michael G Gaies6. 1. From the Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama. 3. Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, Lucille Packard Children's Hospital, Palo Alto, California. 4. Cardiac Intensive Care Unit, Lucille Packard Children's Hospital, Palo Alto, California, Stanford University School of Medicine, Stanford, California, and Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 5. Division of Cardiac Critical Care, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania. 6. Department of Pediatrics and Communicable Diseases, Division of Cardiology, C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Michigan. 7. Department of Pediatrics, The Children's Heart Program of South Carolina, Medical University of South Carolina, Charleston, South Carolina. 8. Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, Ann Arbor, Michigan. 9. Department of Pediatric Critical Care Medicine, University of Pittsburg, Pittsburg, Pennsylvania.
Abstract
BACKGROUND: Healthcare-associated infections (HAIs) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAIs are associated with increased morbidity, mortality and resource utilization. There are few studies describing the epidemiology of HAIs across the entire spectrum of patients (surgical and nonsurgical) receiving care in dedicated pediatric CICUs. METHODS: Retrospective analyses of 22,839 CICU encounters from October 2013 to September 2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry. RESULTS: HAIs occurred in 2.4% of CICU encounters at a rate of 3.3 HAIs/1000 CICU days, with 73% of HAIs occurring in children <1 year. Eighty encounters (14%) had ≥2 HAIs. Aggregate rates for the 4 primary HAIs are as follows: central line-associated blood stream infection, 1.1/1000 line days; catheter-associated urinary tract infections, 1.5/1000 catheter days; ventilator-associated pneumonia, 1.9/1000 ventilator days; surgical site infections, 0.81/100 operations. Surgical and nonsurgical patients had similar HAIs rates/1000 CICU days. Incidence was twice as high in surgical encounters and increased with surgical complexity; postoperative infection occurred in 2.8% of encounters. Prematurity, younger age, presence of congenital anomaly, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT) 4-5 surgery, admission with an active medical condition, open sternum and extracorporeal membrane oxygenation were independently associated with HAIs. In univariable analysis, HAI was associated with longer hospital length of stay and durations of urinary catheter, central venous catheter and ventilation. Mortality was 24.4% in patients with HAIs versus 3.4% in those without, P < 0.0001. CONCLUSIONS: We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.
BACKGROUND: Healthcare-associated infections (HAIs) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAIs are associated with increased morbidity, mortality and resource utilization. There are few studies describing the epidemiology of HAIs across the entire spectrum of patients (surgical and nonsurgical) receiving care in dedicated pediatric CICUs. METHODS: Retrospective analyses of 22,839 CICU encounters from October 2013 to September 2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry. RESULTS: HAIs occurred in 2.4% of CICU encounters at a rate of 3.3 HAIs/1000 CICU days, with 73% of HAIs occurring in children <1 year. Eighty encounters (14%) had ≥2 HAIs. Aggregate rates for the 4 primary HAIs are as follows: central line-associated blood stream infection, 1.1/1000 line days; catheter-associated urinary tract infections, 1.5/1000 catheter days; ventilator-associated pneumonia, 1.9/1000 ventilator days; surgical site infections, 0.81/100 operations. Surgical and nonsurgical patients had similar HAIs rates/1000 CICU days. Incidence was twice as high in surgical encounters and increased with surgical complexity; postoperative infection occurred in 2.8% of encounters. Prematurity, younger age, presence of congenital anomaly, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT) 4-5 surgery, admission with an active medical condition, open sternum and extracorporeal membrane oxygenation were independently associated with HAIs. In univariable analysis, HAI was associated with longer hospital length of stay and durations of urinary catheter, central venous catheter and ventilation. Mortality was 24.4% in patients with HAIs versus 3.4% in those without, P < 0.0001. CONCLUSIONS: We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.
Authors: Cathy Woodward; Richard Taylor; Minnette Son; Roozbeh Taeed; Marshall L Jacobs; Lauren Kane; Jeffrey P Jacobs; S Adil Husain Journal: World J Pediatr Congenit Heart Surg Date: 2017-07
Authors: Anthony A Sochet; Alexander M Cartron; Aoibhinn Nyhan; Michael C Spaeder; Xiaoyan Song; Anna T Brown; Darren Klugman Journal: World J Pediatr Congenit Heart Surg Date: 2017-01
Authors: Howard E Jeffries; Wilbert Mason; Melanie Brewer; Katie L Oakes; Esther I Muñoz; Wendi Gornick; Lee D Flowers; Jodi E Mullen; Craig Harris Gilliam; Stana Fustar; Cary W Thurm; Tina Logsdon; William R Jarvis Journal: Infect Control Hosp Epidemiol Date: 2009-07 Impact factor: 3.254
Authors: Sara K Pasquali; Xia He; Marshall L Jacobs; Matthew Hall; J William Gaynor; Samir S Shah; Eric D Peterson; Kevin D Hill; Jennifer S Li; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2013-06-28 Impact factor: 4.330
Authors: Michael Gaies; David S Cooper; Sarah Tabbutt; Steven M Schwartz; Nancy Ghanayem; Nikhil K Chanani; John M Costello; Ravi R Thiagarajan; Peter C Laussen; Lara S Shekerdemian; Janet E Donohue; Gina M Willis; J William Gaynor; Jeffrey P Jacobs; Richard G Ohye; John R Charpie; Sara K Pasquali; Mark A Scheurer Journal: Cardiol Young Date: 2014-08-28 Impact factor: 1.093
Authors: John M Costello; Dionne A Graham; Debra Forbes Morrow; Gail Potter-Bynoe; Thomas J Sandora; Peter C Laussen Journal: Pediatr Crit Care Med Date: 2009-07 Impact factor: 3.624
Authors: Michael Levy; Stéphane Bonacorsi; Jérôme Naudin; Marion Caseris; Eric Thebault; Patricia Mariani-Kurkdjian; Maryline Chomton; Julie Sommet; Stéphane Dauger; Catherine Doit Journal: Intensive Care Med Date: 2019-03-06 Impact factor: 17.440
Authors: Laura Boulos; Joseph D Kuebler; Ron Angona; Dawn Sweeney; Hongyue Wang; Elizabeth Nocera; Jill M Cholette Journal: J Extra Corpor Technol Date: 2021-09
Authors: Maria von Stumm; Yola Leps; Luca Jochheim; Victoria van Rüth; Urda Gottschalk; Goetz Mueller; Rainer Kozlik-Feldmann; Mark G Hazekamp; Joerg S Sachweh; Daniel Biermann Journal: PLoS One Date: 2022-05-23 Impact factor: 3.752
Authors: Julia García Mancebo; Sara de la Mata Navazo; Estíbaliz López-Herce Arteta; Rosario Montero Mateo; Isabel María López Esteban; Adriana Mazzuchelli Domínguez; María Sánchez Doutel; Jesús López-Herce Cid; Rafael González Cortés Journal: Sci Rep Date: 2021-02-25 Impact factor: 4.379