Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 11 ( November, 2021 ) > List of Articles

Pediatric Critical Care

Healthcare-associated Infections in Pediatric Patients in Neurotrauma Intensive Care Unit: A Retrospective Analysis

Chandrakant Prasad, Ashish Bindra, Parul Singh, Gyaninder P Singh, Pankaj K Singh, Purva Mathur

Keywords : Healthcare-associated infection, Pediatric, Trauma, Traumatic brain injury

Citation Information : Prasad C, Bindra A, Singh P, Singh GP, Singh PK, Mathur P. Healthcare-associated Infections in Pediatric Patients in Neurotrauma Intensive Care Unit: A Retrospective Analysis. Indian J Crit Care Med 2021; 25 (11):1308-1313.

DOI: 10.5005/jp-journals-10071-24012

License: CC BY-NC 4.0

Published Online: 16-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Healthcare-associated infections (HAIs) can impact the outcome following traumatic brain injury (TBI) in children. We undertook a retrospective observational study to see the incidence, risk factors, and microbiological profile for HAIs in pediatric TBI. We also studied the impact of baseline patient characteristics, HAIs on patient outcome, and antibiotic resistance of different types of bacteria. Materials and methods: Data on pediatric TBI patients of age up to 12 years were collected via a computerized patient record system (CPRS) from January 2012 to December 2018. Descriptive Chi-square test and Wilcoxon signed rank test were used to characterize baseline parameters. General linear regression models were run to find an unadjusted and adjusted odds ratio (OR). Results: HAIs were found in 144 (34%) out of 423 patients. The most commonly seen infections were of the respiratory tract in 73 (17.26%) subjects. The most predominant microorganism isolated was Acinetobacter baumannii in 188 (41%) samples. A. baumannii was sensitive to colistin in 91 (48.4%) patients. Male gender (OR 0.630; p-value 0.035), fall from height (OR 0.374; p-value 0.008), and higher injury severity scale (ISS) (OR 1.040; p-value 0.002) were independent risk factors for development of HAIs. Severe TBI, higher ISS and Marshall grade, and HAIs were significantly associated with poor patient outcome. Conclusion: Severe TBI poses a significant risk of HAIs. The most common site was the respiratory tract, predominately infected with A. baumannii. HAIs in pediatric TBI patients resulted in poor patient outcome.


HTML PDF Share
  1. Shekhar C, Gupta LN, Premsagar IC, Sinha M, Kishore J. An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India). J Emerg Trauma Shock 2015;8(3):131–139. DOI: 10.4103/0974-2700.160700. PMID: 26229295; PMCID: PMC4520025.
  2. Araki T, Yokota H, Morita A. Pediatric Traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir (Tokyo) 2017;57(2):82–93. DOI: 10.2176/nmc.ra.2016-0191.
  3. Cardozo Júnior LC, Silva RR. Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality. Rev Bras Ter Intensiva 2014;26(2):148–154. DOI: 10.5935/0103-507x.20140022.
  4. Cutler GJ, Kharbanda AB, Nowak J, Ortega HW. Injury region and risk of hospital-acquired pneumonia among pediatric trauma patients. Hosp Pediatr 2017;7(3):164–170. DOI: 10.1542/hpeds.2016-0072.
  5. Boddie DE, Currie DG, Eremin O, Heys SD. Immune suppression and isolated severe head injury: a significant clinical problem. Br J Neurosurg 2003;17(5):405–417. DOI: 10.1080/02688690310001611198.
  6. Bronchard R, Albaladejo P, Brezac G, Geffroy A, Seince PF, Morris W, et al. Early onset pneumonia: risk factors and consequences in head trauma patients. Anesthesiology 2004;100(2):234–239. DOI: 10.1097/00000542-200402000-00009.
  7. Mahadewa TGB, Golden N, Saputra A, Ryalino C. Modified Revised Trauma-Marshall score as a proposed tool in predicting the outcome of moderate and severe traumatic brain injury. Open Access Emerg Med 2018;8(10):135–139. DOI: 10.2147/OAEM.S179090.
  8. Lecky F, Woodford M, Edwards A, Bouamra O, Coats T. Trauma scoring systems and databases. Br J Anaesth 2014;113(2):286–294. DOI: 10.1093/bja/aeu242.
  9. Elward AM, Hollenbeak CS, Warren DK, Fraser VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115(4):868–872. DOI: 10.1542/peds.2004-0256.
  10. Sribnick EA, Hensley J, Moore-Clingenpeel M, Muszynski JA, Thakkar RK, Hall MW. Nosocomial infection following severe traumatic injury in children. Pediatr Crit Care Med 2020;21(5):443–450. DOI: 10.1097/PCC.0000000000002238.
  11. Osborn TM, Tracy JK, Dunne JR, Pasquale M, Napolitano LM. Epidemiology of sepsis in patients with traumatic injury. Crit Care Med 2004;32(11):2234–2240. DOI: 10.1097/01.ccm.0000145586.23276.
  12. Ortega HW, Cutler G, Dreyfus J, Flood A, Kharbanda A. Hospital-acquired pneumonia among pediatric trauma patients treated at national trauma centers. J Trauma Acute Care Surg 2015;78(6):1149–1154. DOI: 10.1097/TA.0000000000000661.
  13. 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. DOI: 10.1093/tropej/fml073.
  14. Green N, Johnson AP, Henderson KL, Muller-Pebody B, Thelwall S, Robotham JV, et al. Quantifying the burden of hospital-acquired bloodstream infection in children in England by estimating excess length of hospital stay and mortality using a multistate analysis of linked, routinely collected data. J Pediatric Infect Dis Soc 2015;4(4):305–312. DOI: 10.1093/jpids/piu073.
  15. Alharfi IM, Charyk Stewart T, Al Helali I, Daoud H, Fraser DD. Infection rates, fevers, and associated factors in pediatric severe traumatic brain injury. J Neurotrauma 2014;31(5):452–458. DOI: 10.1089/neu.2013.2904.
  16. Ngo QN, Ranger A, Singh RN, Kornecki A, Seabrook JA, Fraser DD. External ventricular drains in pediatric patients. Pediatr Crit Care Med 2009;10(3):346–351. DOI: 10.1097/PCC.0b013e3181a320cd.
  17. Hamele M, Stockmann C, Cirulis M, Riva-Cambrin J, Metzger R, Bennett TD, et al. Ventilator-associated pneumonia in pediatric traumatic brain injury. J Neurotrauma 2016;33(9):832–839. DOI: 10.1089/neu.2015.4004.
  18. Musyoki VM, Masika MM, Mutai W, Wilfred G, Kuria A, Muthini F. Antimicrobial susceptibility pattern of Acinetobacter isolates from patients in Kenyatta National Hospital, Nairobi, Kenya. Pan Afr Med J 2019;26(33):146. DOI: 10.11604/pamj.2019.33.146.17220.
  19. Wang C, Yuan Z, Huang W, Yan L, Tang J, Liu CW. Epidemiologic analysis and control strategy of Klebsiella pneumoniae infection in intensive care units in a teaching hospital of People's Republic of China. Infect Drug Resist 2019;12(12):391–398. DOI: 10.2147/IDR.S189154.
  20. Gitau W, Masika M, Musyoki M, Museve B, Mutwiri T. Antimicrobial susceptibility pattern of Staphylococcus aureus isolates from clinical specimens at Kenyatta National Hospital. BMC Res Notes 2018;11(1):226. DOI: 10.1186/s13104-018-3337-2.
  21. Gondim R, Azevedo R, Braga AANM, Veiga ML, Barroso U Jr. Risk factors for urinary tract infection in children with urinary urgency. Int Braz J Urol 2018;44(2):378–383. DOI: 10.1590/S1677-5538.IBJU.2017.0434.
  22. Bedry T, Tadele H. Pattern and outcome of pediatric traumatic brain injury at Hawassa University comprehensive specialized hospital, Southern Ethiopia: observational cross-sectional study. Emerg Med Int 2020;2020:1965231. DOI: 10.1155/2020/1965231.
  23. Sundberg J, Estrada C, Jenkins C, Ray J, Abramo T. Hypothermia is associated with poor outcome in pediatric trauma patients. Am J Emerg Med 2011;29(9):1019–1022. DOI: 10.1016/j.ajem.2010.06.002.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.