PROSPECTIVE SURVEILLANCE OF DEVICE-ASSOCIATED INFECTIONS IN PEDIATRIC INTENSIVE CARE UNITS IN GREECE: A MULTICENTRE STUDY
- Stavroula Ilia, Greece
- Stavroula Ilia, Greece
- Panajiotis Briassoulis,
- Eleni Christakou, Greece
- Maria Machaira, Greece
- Athanasios Kassimis,
- Eleni Volakli,
- Filippia Nikolaou,
- Charikleia Barbaresou, Greece
- Argiro Messaritaki,
- Achilleas Gikas,
- George Briassoulis,
Abstract
Background
Surveillance of health care-associated infections (HAIs) plays a key role in infection control and management.
Objectives
To identify the incidence of 3 device-associated HAIs (DA-HAIs) in pediatric intensive care units (PICUs) in Greece: catheter-related bloodstream infection (CRI), intubation-associated pneumonia (IAP) and catheter-associated urinary tract infection (CAUTI).
Methods
Prospective surveillance study (July-December 2017) was conducted in four PICUs in Greece using European Centre for Disease Prevention and Control(ECDC) HAI-net ICU protocol, version 2.2. Included patients were admitted for >48 hours to PICU. Medical records were assessed daily. Patient–days, device-days, demographics, severity illness score, susceptibility of isolated pathogens, and outcome were recorded.
Results
153 children were included with median age 4 years (IQR, 1-9), 88 (57.5%) male, median PRISM III 5 (IQR, 3-8), and median length of stay (LOS) 7 days (IQR, 4-15). Crude mortality was 7.8%. Device utilization rates of central line, intubation devices and urinary catheters were 0.79, 0.65, and 0.70, respectively. CRI, IAP and CAUTI rates were 2.32, 10.5 and 4.6 per 1,000device-days. 14(35%) microbiologically confirmed blood stream infections (BSI) out of 40 HAIs were of unknown origin. Patients with DA-HAIs had greater severity score (p<0.001) and increased LOS (28.5 vs 6 days, p<0.001). Enterobacteriae spp(16/40) were the most commonly found pathogens. Carbapenem resistance was 43.8% for Klebsiella pneumoniae, 33.3% for Pseudomonas aeruginosa and 80% for Acinetobacter baumanii.
Conclusion
Active surveillance of DA-HAIs has never been performed in a multicentre PICU setting in Greece. DA-HAIs incidence and isolate resistance rates stress the need for infection control bundles and antimicrobial stewardship interventions.