Health Care-Associated Infections Among Critically III Children in the US, 2007-2012
Health Care-Associated Infections Among Critically III Children in the US, 2007-2012
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DOI：
10.1542/peds.2014-0613
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发表时间：
2014-10-01
期刊：
影响因子：
8
通讯作者：
Lee, Grace M.
中科院分区：
文献类型：
--
作者：
Patrick, Stephen W.;Kawai, Alison Tse;Lee, Grace M.
背景技术背景：卫生保健相关感染（HAI）是有害的和昂贵的，并可能导致住院儿童的大量发病率;然而，对新生儿和儿科人群中HAI的全国趋势知之甚少。我们的目的是确定2007年至2012年美国大样本医院中重症儿童的HAI发生率。方法：在这项队列研究中，我们纳入了位于医院的NICU和PICU，这些医院向疾病控制和预防中心的国家医疗安全网络报告了中心静脉导管相关血流感染（CLABSI）、呼吸机相关肺炎、和导尿管相关的尿路感染。我们采用了时间序列设计，以评估HAI率的变化。结果：共有173家美国医院提供了来自NICU的数据，64家提供了来自PICU的数据。从2007年至2012年，NICU的CLABSI发生率从每1000中心线日4.9例降至1.5例（每季度的发病率比（IRR）= 0.96，95%置信区间0.94-0.97），PICU从每1000中心线日4.7例降至1.0例（每季度的IRR = 0.96 [0.94-0.98]）。NICU的呼吸机相关肺炎发生率从1.6/1000呼吸机日降至0.6/1000呼吸机日（IRR/季度= 0.97 [0.93-0.99]），PICU从1.9/1000呼吸机日降至0.7/1000呼吸机日（IRR/季度= 0.95 [0.92-0.98]）。导管相关性尿路感染的发生率在PICUs.CONCLUSIONS中没有显著变化：2007年至2012年间，住院新生儿和儿童的HAI大幅减少。儿科2014; 134：705-712
BACKGROUND: Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012.METHODS: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates.RESULTS: A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 centralline days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilatorassociated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs.CONCLUSIONS: Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children. Pediatrics 2014; 134: 705-712