Burden, spectrum and impact of healthcare-associated infection at a South African children’s hospital

Abstract Introduction In most African countries the burden, spectrum and impact of paediatric healthcare-associated infections (HAI), and the effect of HIV infection, is unknown. Methods Continuous prospective clinical and laboratory HAI surveillance using CDC/NHSN definitions was conducted at Tyger...

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Bibliographic Details
Published in:The Journal of hospital infection 2016-12, Vol.94 (4), p.364-372
Main Authors: Dramowski, Angela, Whitelaw, Andrew, Cotton, Mark F
Format: Article
Language:English
Subjects:
Adolescent
Antimicrobial resistance
Child
Child, Preschool
Cross Infection - economics
Cross Infection - epidemiology
Cross Infection - mortality
Cross Infection - pathology
Female
Health Care Costs
Healthcare-associated infection
Hospitals, Pediatric
Humans
Incidence
Infant
Infant, Newborn
Infection prevention
Infectious Disease
Length of Stay
Male
Nosocomial infection
Paediatrics
Prevalence
Prospective Studies
Risk Factors
South Africa - epidemiology
Sub-Saharan Africa
Survival Analysis
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Summary:Abstract Introduction In most African countries the burden, spectrum and impact of paediatric healthcare-associated infections (HAI), and the effect of HIV infection, is unknown. Methods Continuous prospective clinical and laboratory HAI surveillance using CDC/NHSN definitions was conducted at Tygerberg Children’s Hospital, South Africa from 1 May to 31 October in 2014 and 2015. Risk factors for HAI and associated mortality were analyzed with multivariable logistic regression; excess length of stay was estimated using a confounder and time-matching approach. Results HAI incidence density was 31.1/1000 patient-days [95%CI 28.2–34.2]; hospital-acquired pneumonia (185/417; 44%), urinary tract (UTI) (45/417; 11%), bloodstream (BSI) (41/417; 10%) and surgical site infections (21/417; 5%) predominated. Device-associated HAI incidence in the paediatric intensive care unit (PICU) was high: 15.9, 12.9 and 16 per 1000 device days for ventilator-associated pneumonia, central line-associated BSI and catheter-associated UTI, respectively. HAI was significantly associated with PICU stay (OR 2.0), malnutrition (OR 1.6), HIV-infection (OR 1.7), HIV-exposure (OR 1.6), McCabe score ‘fatal’ (OR 2.0), co-morbidities (OR 1.6), indwelling devices (OR 1.9), blood transfusion (OR 2.5) and transfer-in (OR 1.4). Two-thirds of paediatric deaths were HAI-associated occurring at a median of 4 days from HAI onset with significantly higher crude mortality for HAI-affected vs HAI-unaffected hospitalizations (24/325 [7.4%] vs 12/1022 [1.2%]; p
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2016.08.022