Prevalence and Anti-Microbial Susceptibility of Hospital Acquired Infections in Two Pediatric Intensive Care Units in Egypt
DOI:
https://doi.org/10.3889/oamjms.2019.485Keywords:
Hospital-acquired infection, Pediatric ICU, Anti-microbial, EgyptAbstract
BACKGROUND: Hospital-acquired (nosocomial) infection is a common serious health problem worldwide, especially in pediatric intensive care units and is associated with high mortality and morbidity, prolonged hospital stays and high cost.
AIM: To determine the types of organisms involved in hospital-acquired an infection in two pediatric intensive care units during the one-year study and its anti-microbial susceptibility.
MATERIAL AND METHODS: This study was carried out in the pediatric intensive care units (PICU) of Ain Shams & Cairo Universities, where 86 pediatric patients were recruited. Their age ranged from 1 month to 156 months with mean 20.7 ± 25.8 months. Male to female ratio was 37:29. Four samples were collected from each child for culture and sensitivity: blood, endotracheal aspirate, urine and skin swab.
RESULTS: The most common microorganism was staphylococcus while Gram-negative bacteria were the commonest group. Amikacin and imipenem are the most sensitive antibiotics. Risk estimate for different risk factors among studied patients revealed no significance.
CONCLUSION: Staphylococcus was the commonest micro-organism while Gram-negative infections were the commonest group among PICU with a predominance of Acinetobacter and Klebsiella. Respiratory infections were the most common, followed by blood-borne infection. Risk factors for mortality were not significant.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Abramczyk ML, Carvalho WB, Carvalho ES, Medeiros EA. Nosocomial infection in a pediatric intensive care unit in a developing country. Braz J Infect Dis. 2003; 7:375-80. https://doi.org/10.1590/S1413-86702003000600004 PMid:14636476
Akash Deep, R. Ghildiyal, S. Kandian and N. Shinkre. Clinical and Microbiological Profile of Nosocomial Infections in the Pediatric Intensive Care Unit (PICU). Indian Pediatrics. 2004; 41:1238-1246.
Alotaibi MG, Rahman S, Al-Shalaan MA, Omair A. Frequency of Nosocomial Infections in Pediatric Intensive Care Unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia. J Infect Dis Ther. 2015; 3(5):234-236. https://doi.org/10.4172/2332-0877.1000234
Campins M, Vaque J, Rosello J, Salcedo S, Duran M, Monge V, Garcia Caballero J, Saenz MC, Calbo F, Armadans L. Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. Am J Infect Control. 1993; 21:8-63. https://doi.org/10.1016/0196-6553(93)90225-S
Choudhury J, Mohanty D, Routray S S. Microbiological profile of Nosocomial infections in the pediatric patients admitted to intensive care unit: Int J Pediatr Res. 2016; 3(2):100-104.
Correia M, Simao C, Lito LM, Cabecadas M, Almeida H, Carvalho A, et al. Nosocomial infections in a Pediatric Intensive Care Unit. Acta Med Port. 1997; 10:463-468.
Daniel WW. Biostatistics: A foundation for analysis in the health sciences. 7th (ed.) John Wiley and Sons. Inc., New York. 2000:166-7.
El-Nawawy AA, Abd El-Fattah MM, Metwally HA, Barakat SS, Hassan IA. One year study of bacterial and fungal nosocomial infections among patients in pediatric intensive care unit (PICU) in Alexandria. J Trop Pediatr. 2006; 52:185-191. https://doi.org/10.1093/tropej/fmi091 PMid:16186137
Garner JS, JarvisWR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988; 16:128-40. https://doi.org/10.1016/0196-6553(88)90053-3
Garrouste-Orgeas M, Timsit JF, Taffet M, Misset B, Zahar JR, Soufir L, et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis. 2006; 42:1118-26. https://doi.org/10.1086/500318 PMid:16575729
Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD, Stover BH, Jarvis WR; Pediatric Prevention Network. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr. 2002; 140:432-438. https://doi.org/10.1067/mpd.2002.122499 PMid:12006957
Hmamouchi B, Chakkouri K, Nejmi SE, Chlilek A. Epidemiology of nosocomial infection in a paediatric intensive care unit. Ann Fr Anesth Reanim. 2005; 24:699-700. https://doi.org/10.1016/j.annfar.2005.04.011 PMid:15921880
Jordan Garcia I, Esteban Torné E, Bustinza Arriortua A, de Carlos Vicente JC, GarcÃa Soler P, Concha Torre JA, Flores González JC, Madurga Revilla P, Palomar MartÃnez M; VINCIP Study Group, from Spanish Society of Pediatric Intensive Care (SECIP). Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units. Enferm Infecc Microbiol Clin. 2016; 34(5):286-92. https://doi.org/10.1016/j.eimc.2015.07.010 PMid:26364857
Kepenekli E, Soysal A, Yalindag-Ozturk N, Ozgur O, Ozcan I, Devrim I, Akar S, Bakir M; Turkish PICU-HCAI Study Group (2015) A national point-prevalence survey of pediatric intensive care unit-acquired, healthcare-associated infections in Turkey. Jpn J Infect Dis. 2015; 13:1-17.
Laupland KB, Lee H, Gregson DB, Manns BJ. Cost of intensive care unit-acquired bloodstream infections. J Hosp Infect. 2006; 63: 124-32. https://doi.org/10.1016/j.jhin.2005.12.016 PMid:16621137
Legras A, Robert R. Nosocomial infection: prospective survey of incidence in 5 French ICUs. Intensive Care Medicine. 1999; 24:1040-1046. https://doi.org/10.1007/s001340050713
Marcelo L. Abramczyk, Werther B. Carvalho, Eduardo S. Carvalho and Eduardo A. S. Medeiros. Nosocomial Infection in a Pediatric Intensive Care Unit in a Developing Country. The Brazilian Journal of Infectious Diseases. 2003; 7(6):375-380. https://doi.org/10.1590/S1413-86702003000600004
Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med. 1982; 307(8):463-8. https://doi.org/10.1056/NEJM198208193070802 PMid:7099208
Clarridge JE, Johnson JR, Pezzlo MT, Cumitech B: laboratory diagnosis of urinary tract infections, Washington, DC American Society for Microbiology, 1998.
Lennette EH, Balows A, Hausler WJ, et al. Manual of clinical microbiology. Washington: American Society for Microbiology, 1985.
Isenberg HD, Schoenknecht FD, von Graevenitz A. Cumulative techniques: collection and processing of bacteriologic specimens. Washington: American Society for Microbiology, 1979.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 17th informational supplement. CLSI document M100-S17. Wayne, PA: CLSI, 2007.
MarÃa R Becerra1, José A Tantaleán, VÃctor J Suárez, Margarita C Alvarado, Jorge L Candela, Flor C Urcia. Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country. BMC Pediatrics. 2010:10:66. https://doi.org/10.1186/1471-2431-10-66 PMid:20831797 PMCid:PMC2944329
Nejla Ben Jaballah, MD, Asma Bouziri, MD, Khaled Mnif, MD, Asma Hamdi, MD, Ammar Khaldi, MD, and Wassim Kchaou, MD. Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: A 2-year prospective study. Am J Infect Control. 2007; 35:613-8. https://doi.org/10.1016/j.ajic.2006.09.007 PMid:17980241
Raymond J, Aujard Y, European Study Group. Nosocomial infections in pediatric patients a European, multicenter prospective study. Infection Control & Hospital Epidemiology. 2000; 21(4):260-3. https://doi.org/10.1086/501755 PMid:10782588
Atici S, Soysal A, Kadayifci EK, Karaaslan A, Akkoç G, Yakut N, Demir SÖ, Girgin Fİ, Çulha G, Altınkanat G, Öztürk N. Healthcare-associated infections in a newly opened pediatric intensive care unit in Turkey: Results of four-year surveillance. The Journal of Infection in Developing Countries. 2016; 10(03):254-9. https://doi.org/10.3855/jidc.7517 PMid:27031457
Balaban İ, Tanır G, Timur ÖM, Öz FN, Teke TA, Bayhan Gİ, Sözak N, Göl N. Nosocomial infections in the general pediatric wards of a hospital in Turkey. Japanese journal of infectious diseases. 2012; 65(4):318-21. https://doi.org/10.7883/yoken.65.318 PMid:22814155
Aktar F, Tekin R, Güneş A, Ülgen C, Tan I, Ertugrul S, Köşker M, Balık H, Karabel D, Yolbaş I. Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients. BioMed Research International. 2016:1-5. https://doi.org/10.1155/2016/7240864 PMid:26981536 PMCid:PMC4770130
Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, et al. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect. 2006; 62:207-213. https://doi.org/10.1016/j.jhin.2005.06.032 PMid:16307822
Ashkenazi S, Leibovici L, Samra Z, Konisberger H, Drucker M. Risk factors for mortality due to bacteremia and fungemia in childhood. Clinical infectious diseases. 1992; 14(4):949-51. https://doi.org/10.1093/clinids/14.4.949 PMid:1576293
Brun-Buisson C, Meshaka P, Pinton P, Vallet B. EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004; 30(4):580-588. https://doi.org/10.1007/s00134-003-2121-4 PMid:14997295
Engel C, Brunkhorst FM, Bone HG, et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med. 2007; 33(4):606-618. https://doi.org/10.1007/s00134-006-0517-7 PMid:17323051
Esteban A, Frutos-Vivar F, Ferguson ND, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med. 2007; 35(5):1284-1289. https://doi.org/10.1097/01.CCM.0000260960.94300.DE PMid:17414725
Fortaleza CM, Caldeira SM, Moreira RG, Akazawa RT, Corrente JE, Souza LR, et al. Tropical healthcare epidemiology: weather determinants of the etiology of bloodstream infections in a Brazilian hospital. Infect Control Hosp Epidemiol. 2014; 35(1):85-88. https://doi.org/10.1086/674392 PMid:24334804
Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time? Crit Care Med. 1998; 26(12):2078-2086. https://doi.org/10.1097/00003246-199812000-00045 PMid:9875924
Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006; 10(2):R42.
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K. International study of the prevalence and outcomes of infection in intensive care units. Jama. 2009; 302(21):2323-9. https://doi.org/10.1001/jama.2009.1754 PMid:19952319
Karlsson S, Varpula M, Ruokonen E, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med. 2007; 33(3):435-443. https://doi.org/10.1007/s00134-006-0504-z PMid:17225161
Lee CY, Chen PY, Huang FL, Lin CF. Microbiologic spectrum and susceptibility pattern of clinical isolates from the pediatric intensive care unit in a single medical center-6 years' experience. J Microbiol Immunol Infect. 2009; 42(2):160-5.
Lisa A. Grohskopf, Ronda L. Sinkowitz-Cochran, Denise O. Garrett, Annette H. Sohn, Gail L. Levine, Jane D. Siegel, Beth H. Stover, William R. Jarvis, and the Pediatric Prevention Network. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. Journal of Pediatrics. 2002; 140(4):432-438. https://doi.org/10.1067/mpd.2002.122499 PMid:12006957
Martin CM, Priestap F, Fisher H, et al. STAR Registry Investigators. A prospective, observational registry of patients with severe sepsis: the Canadian Sepsis Treatment and Response Registry. Crit Care Med. 2009; 37(1):81-88. https://doi.org/10.1097/CCM.0b013e31819285f0 PMid:19050636
Mireya UA, Marti PO, Xavier KV, Cristina LO, Miguel MM, Magda CM. Nosocomial infections in pediatric and neonatal intensive care units. Journal of infection. 2007; 54:212-220. https://doi.org/10.1016/j.jinf.2006.03.023 PMid:16678905
Rasslan O, Seliem ZS, Ghazi IA, El Sabour MA, El Kholy AA, Sadeq FM, Kalil M, Abdel-Aziz D, Sharaf HY, Saeed A, Agha H. Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings. Journal of infection and public health. 2012; 5(6):394-402. https://doi.org/10.1016/j.jiph.2012.07.002 PMid:23287610
Richards MJ, Edwards JR, Culver DH, et al. Nosocomial Infections in Pediatric Intensive Care Units in the United States. Pediatrics. 1999; 103:804. https://doi.org/10.1542/peds.103.4.e39 PMid:10103331
Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for isolation precautions preventing transmission of infectious agents in healthcare settings, 2007. https://doi.org/10.1016/j.ajic.2007.10.007 PMid:18068815
Silva E, Pedro MA, Sogayar AC, et al. Brazilian Sepsis Epidemiological Study. Brazilian Sepsis Epidemiological Study (BASES study). Crit Care. 2004; 8(4):R251-R260.
Caldeira SM, Cunha AR, Akazawa RT, Moreira RG, Souza LD, Fortaleza CM. Weather parameters and nosocomial bloodstream infection: a case-referent study. Revista de saude publica. 2015; 49:19. https://doi.org/10.1590/S0034-8910.2015049005438 PMid:25830871 PMCid:PMC4390072
Spencer RC. Predominant pathogens found in the European Prevalence of Infection in Intensive Care study. Eur J Clin Microbiol Infect Dis. 1996; 15(4):281-285. https://doi.org/10.1007/BF01695658 PMid:8781877
Sundararajan V, Macisaac CM, Presneill JJ, Cade JF, Visvanathan K. Epidemiology of sepsis in Victoria, Australia. Crit Care Med. 2005; 33(1):71-80. https://doi.org/10.1097/01.CCM.0000150027.98160.80 PMid:15644651
Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J. 2003; 22:490-493. https://doi.org/10.1097/01.inf.0000069758.00079.d3 PMid:12799503
van Gestel A, Bakker J, Veraart CP, van Hout BA. Prevalence and incidence of severe sepsis in Dutch intensive care units. Crit Care. 2004; 8(4):R153-R162. https://doi.org/10.1186/cc2858 PMid:15312213 PMCid:PMC522831
Vincent JL, Sakr Y, Sprung CL, et al. Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006; 34(2):344-353. https://doi.org/10.1097/01.CCM.0000194725.48928.3A PMid:16424713
Zingg W, Hopkins S, Gayet-Ageron A, Holmes A, Sharland M, Suetens C, Almeida M, Asembergiene J, Borg MA, Budimir A, Cairns S. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. The Lancet Infectious Diseases. 2017; 17(4):381-9. https://doi.org/10.1016/S1473-3099(16)30517-5
Yallew WW, Kumie A, Yehuala FM. Point prevalence of hospital-acquired infections in two teaching hospitals of Amhara region in Ethiopia. Drug Healthc Patient Saf. 2016; 8:71-6. https://doi.org/10.2147/DHPS.S107344 PMid:27601932 PMCid:PMC5003516
Záhorec R, Firment J, Straková J, et al. Epidemiology of severe sepsis in intensive care units in the Slovak Republic. Infection. 2005; 33(3):122-128. https://doi.org/10.1007/s15010-005-4019-2 PMid:15940412
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Sally El-Sahrigy, Mohamed G. Shouman, Hanan Ibrahim, Azza Abdel Rahman, Sonia Adolf Habib, Aser A. Khattab, Howayda A. Gomaa, Naiven Helmy (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0