Supervisors info:
Νικόλαος Σπυρίδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαρίζα Τσολιά, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αθανάσιος Μίχος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Hospital – acquired infections (HAI) is a major public health problem, linked with increased morbidity, mortality, hospital expenses and prolonged hospital stays. The consequences in vulnerable population such as patients with immunosuppression or with malignancies are significant as they increase risk of death. For all the above reasons, healthcare systems should apply infection surveillance policies and develop evidence-based processes that can lead to significant reductions in hospital-acquired infections in children.
To our knowledge, there is lack of evidence on epidemiology, risk factors and mortality that is caused by nosocomial infections in pediatric patients. As in adults, HAIs are common in pediatric patients, however, both the rates, site and microbiology of pediatric HAI differ from those experienced by hospitalized adults. For example, in children CLABSIs are the most common HAI whereas in adults catheter–associated urinary tract infections (CA-UTIs) predominate. Rates of HAIs among pediatric patients vary according to birthweight, age, underlying diseases, and intensity of medical care. Rates of infection are highest in children <1 year of age and in children who require intensive care, particularly infants in neonatal intensive care units (NICUs). These vulnerable patients often have many of the risk factors that predispose patients of all ages to infections, such as severe underlying illness, loss of skin integrity or the presence of multiple devices that breach normal defense mechanisms. (e. g an endotracheal tube). The prolonged hospital stay, invasive monitoring and supportive care, birth defects and total parenteric nutrition are all factors that have been inversely associated with the risk of nosocomial infection.
A “Healthcare-associated infection (HAI)” is typically defined as any infection not present or incubating at the time of the patient’s initial contact with a healthcare setting that developed 48 hours after admission. Most common nosocomial infections in pediatric population are bloodstream infections (CLABSIs -Central line-associated bloodstream infections), respiratory tract infections, Ventilator -associated pneumonia (VAP), Catheter -associated urinary tract infection (CA-UTIs), gastrointestinal tract infections (Rota-virus gastroenteritis, Clostridium Difficile infection) and Surgical Site Infections (SSIs). Nosocomial infections linked with antibiotic resistant pathogens pose another mayor concern. Τhese bacteria are pathogenic, spread quickly and can dominate in the flora of patients that has as a consequence the appearance of serious infections in critically ill patients with increased mortality. At the same time antibiotic production pipeline has declined dramatically raising the challenge for the medical community. Recent initiatives have demonstrated that the majority of ΗΑΙs can be preventable. Antibiotic Stewardship is a key το combat antimicrobial resistance. Hand hygiene remains the most crucial element of prevention of nosocomial infections. However the implementation of appropriate care bundles while approaching a patient with a central venous catheter is one of the measures that has been proven to improve patients outcome.
Aim : This is a retrospective review of published studies on nosocomial infections in European paediatric hospitals. We aim to document the presence or absence of such studies and identify gaps of knowledge and areas of further research.
Method : A comprehensive literature search was conducted in PubΜed by using permutations of the following keywords: “healthcare-associated infection”, “nosocomial infection” in combination with “children” or “pediatric”. Only articles published in English language between January 2000 until December 2018 with age restriction <18 years old were reviewed. In addition, citations and references from published papers were used to identify other relevant articles.
Keywords:
Healthcare - associated Infections, Healthcare - associated paediatric Infections, Nosocomial Infections, Paediatric Hospital-acquired infections
