The Epidemiology and Impact of Healthcare Associated Infection on Medical Utility and Death among Hospitalized Children
Date Issued
2015
Date
2015
Author(s)
Chuang, Shun-Wen
Abstract
Because of the immunological naivety and having fewer chronic or degenerative organ system disorders, young children present more often with congenital or acquired immune deficiencies as well as congenital syndromes than adults. Therefore, the nosocomial pathogens, most common healthcare associated infection (HAI) sites and antimicrobial-resistant organisms in children differ from those reported among adults. The purpose of the study is to explore the epidemiology and the impact of HAI on medical utility and death among hospitalized children. A retrospective design was conducted for the study. The definition of HAI for the study is based on the definitions defined by the Centers for Disease Control and Prevention in 2008. The population consists of patients under 18 years old, who were hospitalized at a medical center from January 2010 to September 2014. A total of 423 person times were found to have HAI during their hospitalization. The collected data were analyzed by using SPSS (ver. 17) for descriptive statistics, chi-square test, logistic regression and Cox regression. Results: The most frequent sites of infections in hospitalized children were bloodstream infection (44.0%). Bacteria were responsible for gram-negative organisms 59.3% and gram-positive organisms 28.6%. Bloodstream infection, urinary tract infection and respiratory tract infection were most commonly gram-negative organisms. Surgical site infection and skin and soft tissue infection were most commonly gram-positive organisms. The proportion of infections caused by methicillin-resistant coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus (S. aureus) has increased from 2010 to 2014。 In logistic regression analysis, intensive care unit and use two kinds of invansive procedure are two independent predictors of length of stay. Then age (neonates), sex (men), surgical, and ventilator use are independent predictors of onset infection to discharge. The predictive factors for mortality related to HAI (p < 0.05 in the Cox regression model) are: age (>30day~<1year、1~4years、15~18years), sex (men), surgical and use of antibiotics or steroids. Conclusions: We found large differences in HAI frequency and microbial epidemiology in this study. Clinical monitoring of HAIs and bacterial resistance profiles are required in all pediatric units. Describing the epidemiology of HAIs in the hospital enabled us to establish infection occurrence, distribution, and expected incidence, as well as to recognize trends and keep track of possible outbreaks.
Subjects
Healthcare associated infection
medical utility
hospitalized children
Type
thesis
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