Trends in Nosocomial Blood Stream Infection in PICU of a Tertiary Care Hospital

Umer Waqar Azeem; Nighat Sultana; Muhammad Sarwar; Ghazala Shaffqat; Anila Jamil; Sana Jamil

doi:10.51253/pafmj.v74i6.9031

Authors

Umer Waqar Azeem Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan
Nighat Sultana Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan
Muhammad Sarwar Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan
Ghazala Shaffqat Department of Pediatric Medicine, Children Hospital and Institute of Child Health, Faisalabad Pakistan
Anila Jamil Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan
Sana Jamil Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i6.9031

Keywords:

Bloodstream infections, Community-acquired infections, Gram positive, Nosocomial.

Abstract

Objective: To determine the antimicrobial sensitivity pattern for local pathogens in the Pediatric Intensive Care Unit of Children’s Hospital, Lahore, Pakistan, and its impact on patient outcomes.

Study Design: Analytical cross-sectional.

Place and Duration of Study: Children’s Hospital, Lahore, Pakistan, from Feb 2021 to Feb 2022.

Methodology: We enrolled all the children meeting our inclusion criteria and who were admitted to Pediatric Intensive Care Unit. Blood cultures were sent after 48 hours of admission with those having positive blood cultures considered to have nosocomial bloodstream infection. Demographic, microbiological, and other variables were documented on a data collection form. All data was analyzed on Statistical Package for Social Sciences (SPSS) version 26.0.

Results: We enrolled 1,157 pediatric patients with a median age of 3.0 years. Bloodstream Infection was confirmed in 14.7% of patients, with significantly younger patients experiencing bloodstream infection (median age 1.4 years vs. 4.0 years, p=0.002). Bloodstream Infection patients demonstrated markedly longer hospital stays (15.0 vs. 7.0 days, p<0.001) and extended mechanical ventilation duration (9.0 vs. 3.0 days, p=0.003). Microbiological analysis of positive cultures revealed predominance of gram-negative organisms (145(86%), with gram-positive organisms accounting for 14%.

Conclusion: The frequency of nosocomial bloodstream infection in Pediatric Intensive Care Unit was found to be quite high, leading to longer duration of stay and poorer outcomes. The emergence of highly resistant organisms is alarming, which underscores the need for rational use of antibiotics and strict infection control programs.

Downloads

Download data is not yet available.

Author Biographies

Nighat Sultana, Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan
Muhammad Sarwar, Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan

Associate Professor, PICU.

Children Hospital, Lahore – University of Child Health Sciences
Sana Jamil, Department of Pediatric Medicine, Children Hospital, Lahore, University of Child Health Sciences, Lahore Pakistan

Senior Registrar.

Children Hospital, Lahore – University of Child Health Sciences

References

Tauhid SA, Chowdhury M, Hoque MM, Haque E. Nosocomial bloodstream infections in children in intensive care unit: organisms, sources, their sensitivity pattern, and outcome of treatment. J Bangladesh Coll Physicians Surg 2017; 35(3): 115-122. https://doi.org/10.3329/jbcps.v35i3.34341

Porto JP, Mantese OC, Arantase A, Freitas C, Filho PPG, Ribas RM. Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance. Rev Soc Bras Med Trop 2012; 45(4): 475-479. https://doi.org/10.1590/S0037-86822012005000003

Hamid MH, Zafar A, Maqbool S. Nosocomial bloodstream infection in a tertiary care pediatric intensive care unit. J Coll Physicians Surg Pak 2007; 17(7): 416-419.

Pourakbari B, Rezaizadeh G, Mahmoudi S, Mamishi S. Epidemiology of nosocomial infections in pediatric patients in an Iranian referral hospital. J Prev Med Hyg 2012; 53: 204-206.

Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, et al. Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care 2011; 15(2): 100.

https://doi.org/10.1186/cc10114

Ferrer R, Loeches MI, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014; 42(8): 1749-1755. https://doi.org/10.1097/CCM.0000000000000330

Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. Natl Nosocomial Infections Surveillance System. Crit Care Med 1999; 27(5): 887-892.

https://doi.org/10.1542/peds.103.4.e39

Ahmed SH, Daef EA, Badary MS, Mahmoud MA, AbdElsayed AA. Nosocomial bloodstream infection in intensive care units at Assiut University Hospitals with special reference to extended spectrum beta-lactamase producing organisms. BMC Res Notes 2009; 2: 76. https://doi.org/10.1186/1756-0500-2-76

Lakshmi KS, Jayashree M, Singhi S, Ray P. Study of nosocomial primary bloodstream infections in a pediatric intensive care unit. J Trop Pediatr 2007; 53(2): 87-92.

https://doi.org/10.1093/tropej/fml073

Parajuli NP, Parajuli H, Pandit R. Evaluating the trends of bloodstream infections among pediatric and adult patients at a teaching hospital of Kathmandu, Nepal: role of drug-resistant pathogens. Can J Infect Dis Med Microbiol 2017; 2017: 8763135.

https://doi.org/10.1155/2017/8763135

Cui J, Li M, Wang J. The incidence rate, species distribution and dynamic trends of bloodstream infection in China. Res Sq 2020. https://doi.org/10.21203/rs.3.rs-27335/v1

Rezk AR, Bawady SA, Omar NN. Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care. Egypt Pediatr Assoc Gaz 2021; 69: 25. https://doi.org/10.1186/s43054-021-00071-1

Asanathong NW, Rongrungreung Y, Assanasen S. Epidemiology and trends of important pediatric healthcare-associated infections at Siriraj Hospital, Thailand. Southeast Asian J Trop Med Public Health 2017; 48(3): 641-654.

Ulus A, Kara SS, Çelik E. An evaluation of pediatric intensive care unit infection rates and various risk factors. Trends Pediatr 2020; 1(2): 75-80.

https://doi.org/10.5222/TP.2020.66376

Ayaz I, Hameed H, Amber W, Zafar T. Nosocomial bloodstream infections in pediatric intensive care unit of Fauji Foundation Hospital, Rawalpindi Pakistan. J Islamabad Med Dent Coll 2020; 9(4): 269-274.

https://doi.org/10.35787/jimdc.v9i4.533

Duan N, Sun L, Huang C. Microbial distribution and antibiotic susceptibility of bloodstream infections in different intensive care units. Front Microbiol 2021; 12: 792282.

https://doi.org/10.3389/fmicb.2021.792282

Canadian Nosocomial Infection Surveillance Program. Device-associated infections in Canadian acute-care hospitals from 2009 to 2018. Can Commun Dis Rep 2020; 46(11/12): 387-397.

https://doi.org/10.14745/ccdr.v46i1112a05

World Health Organization. WHO strategic priorities on antimicrobial resistance: preserving antimicrobials for today and tomorrow. Geneva: World Health Organization; 2022 (Internet). ISBN 978-92-4-004139-4. Available at:

https://www.who.int/publications/i/item/9789240041387 [Accessed on March 27, 2022].

Havan M, Kendirli T, Perk O. A major clinical challenge in pediatric intensive care unit with pandrug-resistant OXA-48 Klebsiella pneumoniae outbreak. Pediatr Crit Care Med 2018; 19(6S): 106.

https://doi.org/10.1097/01.pcc.0000537648.97463.28

Saeed N, Usman M, Khan EA. An overview of extensively drug-resistant Salmonella Typhi from a tertiary care hospital in Pakistan. Cureus 2019; 11(9): e5663.

https://doi.org/10.7759/cureus.5663

Hughes MJ, Birhane MG, Dorough L. Extensively drug-resistant typhoid fever in the United States. Open Forum Infect Dis 2021; 8(12): ofab572.

https://doi.org/10.1093/ofid/ofab572

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629-655.

https://doi.org/10.1016/S0140-6736(21)02724-0