Evaluation of Healthcare-Acquired Infection Rates in a Pediatric Intensive Care Unit in Turkey

Abstract

Healthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey s national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country s PICU, which may later supply useful data about other pediatric hospitals.