Predictors of mortality in children with nosocomial bloodstream infection

Attributable Mortality for Pediatric and Neonatal Central Line-Associated Bloodstream Infections in Greece

Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 patients with CLABSI and nine non-CLABSI patients died (23.4 vs. 9.6%, respectively, p  = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4-24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = - 1.4-41.8%), without reaching, however, statistical significance. After multiple logistic regression, patients with CLABSI were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28-14.36, p  = 0.018). Survival analysis showed no difference in time to death after study enrollment between patients with CLABSI and non-CLABSI patients (log-rank p  = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.

Importance of lactate/albumin ratio in pediatric nosocomial infection and mortality at different times

Aim: To evaluate the lactate/albumin ratio and its relation to mortality in children with nosocomial infections. Materials & methods: One hundred six children were included in this study. Blood gas and albumin levels were analyzed at the first, 24th and 48th h. Results: The types of detected microbial agents, signs of sepsis, development of septic shock and mortality rates were different. The first-, 24th- and 48th h lactate levels of the children who died were higher than those of the living children, but the albumin levels were lower. The highest area under the curve value for the lactate/albumin ratio was detected at the 24th h. Conclusion: Lactate/albumin ratio can be used to predict mortality in children with nosocomial infections.

Risk factors for healthcare-associated infection among children in a low-and middle-income country

BACKGROUND

Healthcare-associated infections (HAI) are one of significant causes of morbidity and mortality. Evaluating risk factors associated with HAI are important to improve clinical outcomes. We aimed to evaluate the risk factors of HAI in children in a low-to middle-income country.

METHODS

A prospective cohort study was conducted during 43 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to pediatric ICU and pediatric wards > 48 h were eligible. Those eligible patients were observed daily to identify the presence of HAI based on CDC criteria. The risk factors of HAI were identified. Multivariable logistic regression was used to identify independent risk factors.

RESULTS

Total of 2612 patients were recruited. Of 467 were diagnosed as HAI. The cumulative incidence of HAI was 17.9%. In the multivariable analysis; length of stay > 7 days, severe sepsis, use of urine catheter, central venous catheter (CVC), non-standardized antibiotics, and aged < 1 year were independently associated with increased risk of HAI with adjusted OR (95%CI): 5.6 (4.3-7.3), 1.9 (1.3-2.9), 1.9 (1.3-2.6), 1.8 (1.1-2.9), 1.6 (1.2-2.0), and 1.4 (1.1-1.8), respectively.

CONCLUSIONS

This study found that length of stay > 7 days, use of urine catheter and CVC, non-standardized antibiotic use, aged < 1 year, and had a diagnosis of severe sepsis increased risk of HAI.

Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study

BACKGROUND

We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU).

METHODS

This retrospective study enrolled children with septic shock at the PICU of Beijing Children's Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.

RESULTS

A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992-1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307-9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974-60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022-1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806-36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS.

CONCLUSIONS

The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.

Association of blood isolate's multi antibiotic resistance-index on laboratory-confirmed bloodstream infection: A cross-sectional study

Background

A not optimal way of the insertion of the intravenous catheter can be one of the factors that cause bloodstream infection (BSI) that should be confirmed with blood culture, and if positive it is called Laboratory-Confirmed Bloodstream Infection (LCBI). One of the surveillance methods of nosocomial infection that is commonly used is the Multi Antibiotic Resistance (MAR)-Index. The aimed of study was association of MAR-index from blood isolates on LCBI category.

Method

This study used a cross-sectional study with a consecutive sampling method. Data collection for this study includes identification of micromaterial profile, antimicrobial test, MAR-Index, and LCBI category. The analysis used is the Mann Whitney test with p < 0.05.

Result

There were 43 isolates of LCBI 1, 26 isolates of LCBI 2, and none of the LCBI 3. Microorganisms in the LCBI category 1 were Staphylococcus aureus (53.4%), Acinetobacter baumannii (20.9%), Escherichia coli (9.3%), Klebsiella pneumonia (7.0%), Pseudomonas aeruginosa (4.7%), and Enterococcus faecalis (4.7%) with the MAR-Index ranged from 0.22 to 0.91. Microorganisms in the LCBI category 2 were Staphylococcus haemolyticus (69.3%), Staphylococcus epidermidis (19.3%), Staphylococcus hominis (3.8%), Streptococcus viridans (3.8%), and Corynebacterium jeikeium (3.8%) with the MAR-Index ranging between 0.11 and 0.79. There is no significant difference of MAR-index between LCBI 1 and 2 (p = 0.424) and no association of MAR-index on LCBI (p = 0.571).

Conclusion

Most LCBI type 1 is Staphylococcus aureus and LCBI type 2 is Staphylococcus haemolyticus which there is no significant association of MAR-index on LCBIs.

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No significant comparison of MAR-index values in LCBI types 1 and 2.

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The most common type 1 LCBI found was Staphylococcus aureus.

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The most common type 2 LCBI found was Staphylococcus haemolyticus.

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

Background: Bloodstream infection (BSI) is one of the most common serious bacterial infections worldwide and also a major contributor to in-hospital mortality. Determining the predictors of mortality is crucial for prevention and improving clinical prognosis in patients with nosocomial BSI. Methods: A nationwide prospective cohort study was conducted from 2007 until 2016 in 16 teaching hospitals across China. Microbiological results, clinical information, and patient outcomes were collected to investigate the pathogenic spectrum and mortality rate in patients with BSI and identify outcome predictors using multivariate regression, prediction model, and Kaplan-Meier analysis. Results: No significant change was observed in the causative pathogen distribution during the 10-year period and the overall in-hospital mortality was 12.83% (480/3,741). An increased trend was found in the mortality of patients infected with Pseudomonas aeruginosa or Acinetobacter baumannii, while a decreased mortality rate was noted in Staphylococcus aureus-related BSI. In multivariable-adjusted models, higher mortality rate was significantly associated with older age, cancer, sepsis diagnosis, ICU admission, and prolonged hospital stay prior to BSI onset, which were also determined using machine learning-based predictive model achieved by random forest algorithm with a satisfactory performance in outcome prediction. Conclusions: Our study described the clinical and microbiological characteristics and mortality predictive factors in patients with BSI. These informative predictors would inform clinical practice to adopt effective therapeutic strategies to improve patient outcomes.

A cross-sectional multisite exploration of Italian paediatric nurses' reported burnout and its relationship to perceptions of clinical safety and adverse events using the RN4CAST@IT-Ped

AIM

To explore Italian paediatric nurses' reported burnout and its relationship to their perceptions of safety and adverse events.

DESIGN

A cross-sectional study using the RN4CAST@IT-Ped database with a web-based survey design.

METHODS

The RN4CAST@IT-Ped questionnaire was used to collect data in 2017. This comprised three main components: three dimensions (22 items) of the Maslach Burnout Inventory including emotional exhaustion, depersonalization and personal accomplishment. Participants also scored an overall grade of patient safety and estimated the occurrence of adverse clinical events.

RESULTS

Nurses (N = 2,243) reported high levels of burnout. Most rated clinical safety as high. The risk of adverse events ranged from 1.3-12.4%. The degree of burnout appeared to influence the perception of safety and adverse events.

CONCLUSION

The association between nurses' burnout and perceptions of higher rates of adverse events and reduced safety in clinical practice is an important finding. However, it is unclear whether this was influenced by a negative state of mind, and whether reduced safety and increased adverse events negatively influenced nurses' well-being, thus leading to burnout. Regardless, the association between nurses' burnout and these quality concepts needs further exploration to examine the effect, if any, on burnout and safety, and identify supportive mechanisms for nurses.

IMPACT

The association between reported burnout and perception of safety and risk of adverse events in Italian paediatric nurses has been reported for the first time. Nurses reporting burnout are at greater risk of intensely negative perceptions of clinical safety and adverse events. This is an important finding as perceptions can influence practice and behaviours. Quality measures in children's clinical environments need to go beyond obvious indicators to examine nurses' well-being as this also influences quality and safety.