Abstract
Objective: To assess the incidence of healthcare-associated infections (HAI) and the prevalence of pathogens across all pediatric units within a single hospital, and trends in pediatric HAI over a 5-year time period for both device and non-device-associated HAI.
Setting: Four units within an academic acute tertiary care hospital in the United States: pediatric intensive care unit, newborn critical care center, children’s intermediate and cardiac care, and pediatric nursing units.
Patients: Hospitalized children (<18 years of age).
Methods: Review of prospectively obtained, comprehensive hospital-wide surveillance, 2008-2012, from an 806-bed acute care academic hospital. Surveillance data was obtained by trained infection control professionals using CDC/NHSN criteria for HAI.
Results: Over the five-year study period, the leading types of HAI were CLASBI (18.55%), tracheobronchitis (18.03%), and UTI (12.16%). The highest overall infection rate per 1,000 patient-days was in the PICU (11.23), followed by the CICC (4.96), the NCCC (3.87), and the inpatient floors (2.83). The overall infection rate decreased in all pediatric units with the greatest decline in the PICU. The incidence of CLASBI, CAUTI, and UTI decreased significantly, while the incidence of VAP, NVAP, and BSI did not change significantly. From the 954 identified HAI cases, 1131 pathogens were isolated including Staphylococcus aureus (n=156, 13.79%), Escherichia coli (n=104, 9.20%), and Enterococcus sp (n=103, 9.11%).
Introduction
Healthcare-associated infections (HAI) (i.e., infections acquired in a healthcare setting), are a
major concern for patient safety and health outcomes among hospitalized patients. These
infections, which include bloodstream infections (BSI), urinary tract infections (UTI), pneumonia
and respiratory infections, surgical site infections (SSI), and others, are associated with morbidity,
mortality, increased length of stay, and increased financial costs for patients.1 The Centers for Disease Control and Prevention (CDC) reported an estimated 721,800 HAI among 648,000
patients in U.S. acute care hospitals in 2011 although comprehensive child-specific data are not
publically available.2 HAI have received increased attention in recent years and are now viewed
within the medical community as a largely preventable public health concern; a recent study
found that up to 70% of such infections are “reasonably preventable” using current
evidence-based strategies.3 However, the majority of research, discussion, and preventative practices have focused on adult patients. Differences in susceptibility to infection and response to preventative
measures between adults and children are evident in the differing rates of central line-associated
BSI (CLABSI), SSI, ventilator-associated pneumonia (VAP), and catheter-associated UTI
(CAUTI) in national data.4,5 Although several important studies have examined pediatric HAI within a hospital setting, these studies typically focused on a single hospital unit, a single type of
infection, or an analysis of prevalence at a single point in time.6-9 Furthermore, the majority of literature focuses solely on device-associated HAI. Therefore, a comprehensive longitudinal
review of HAI (including those that are non-device-associated) within all pediatric units is
warranted. The overall goal of this study is to add to the evidence base around pediatric HAI in
hopes of better understanding risk factors and effective preventative measures and ultimately
reducing future infection within the pediatric hospitalized population. Our specific study aims were
to determine: (1) differences in HAI incidence across all pediatric units within a single hospital, (2)
prevalence of pathogenic sources of HAI within a single hospital, and (3) trends in pediatric HAI
Methods
This study was conducted at University of North Carolina (UNC) Hospitals, an 806-bed tertiary care facility. During the period analyzed, 2008 through 2012, infection control surveillance was conducted by 5 infection control professionals supervised by 3 full-time faculty (DJW, WAR,
EES-B). Comprehensive hospital-wide surveillance included all CDC-defined sites and was performed in accordance with CDC/NHSN (National Health Care Safety Network) criteria. This research was approved by the institutional review board of UNC Chapel Hill.
The study population was comprised of all patients under 18 years of age hospitalized between 2008 and 2012. There were four pediatric units included in this study: the 20-bed pediatric intensive care unit (PICU), 58-bed newborn critical care center (NCCC), 8-bed children’s intermediate and cardiac care (CICC), and 64-bed pediatric nursing unit(s).
BSI included both primary infections (i.e., those not related to a secondary site) and secondary infections (i.e., bacteremia associated with infection at another site). In accordance with CDC criteria, primary bloodstream infections were considered central catheter–associated if the patient had a catheter in place for more than 48 hours prior to infection and a secondary site of infection was not identified. Respiratory infections included pneumonia, empyema, and other infections of the respiratory tract; tracheobronchitis was reported separately. Pneumonia was categorized as ventilator-associated if the patient had been intubated and received ventilation for more than 48
hours prior to the development of pneumonia; otherwise, it was considered hospital-acquired (i.e.
non-ventilator associated) pneumonia (NVAP).
developed within 48 hours after admission to a new unit were categorized as occurring in the previous unit. Cases were entered into a computerized database after having been reviewed by a nurse supervisor and a physician who specialized in infectious diseases and critical care
medicine. Data available from this prospectively maintained database include the patient’s name, age, sex, admission date, date of infection onset, hospital location, site of infection, presence of indwelling device(s), and infecting pathogen(s). The antimicrobial susceptibilities of the infecting pathogens were recorded on patient case forms but were not entered into the computerized database, with the exception of methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE) species, and multi-drug resistant Pseudomonas aeruginosa (MDRPA). Only pathogens associated with nosocomial infections that met CDC criteria were included in our database (i.e., patients who were colonized but not infected were not included in this study).
The infection rate was defined as the number of nosocomial infections per 1,000 patient-days. Device-associated infection rates were calculated as the number of device-associated infections for a specified body site per 1,000 device-days. The device utilization ratio was calculated as the number of device-days per number of patient-days.
Preliminary analyses were conducted in Excel, and SAS software was used for subsequent analyses of trend-lines and statistical significance. The study did not assess specific infections by unit and year due to the instability of the data due to small numerators.
Results
This study utilized data from the children’s units at UNC Hospitals. During the five-year period of
the study, there were 6,179 total reported HAI at UNC Hospitals. Of these, 15.44% (954) were in
Infection Rates across Units
Over the full five-year study period, the leading types of HAI were CLASBI (18.55%),
tracheobronchitis (18.03%), and UTI (12.16%). VAP (8.81%) and CAUTI (7.02%) also comprised
a sizeable percentage of total infections. One-sixth of infections (16.67%) were an assortment of
other less-common infections including gastroenteritis, conjunctivitis, and meningitis. (Table 1)
Over the study period, the highest overall infection rate per 1,000 patient-days was in the PICU
(11.23), followed by the CICC (4.96), the NCCC (3.87), and the nursing units (2.83). The highest
rates of both CLASBI (3.35 per 1,000 central line-days) and BSI (0.33 per 1,000 patient-days)
were in the CICC. The highest rates of both CAUTI (4.01 per 1,000 catheter days) and UTI (0.94
per 1,000 patient days) were in the PICU. The highest rate of VAP (4.19 per 1,000 ventilator
days) was in the NCCC while the highest non-device pneumonia rate (0.45 per 1,000 patient
days) was in the PICU. The rate of tracheobronchitis was higher in the PICU (3.66 per 1,000
patient days) than the other units included in this study. The PICU and the nursing units saw the
highest rates of SSI (0.64 and 0.45 per 1,000 patient days, respectively). (Table 2).
Pathogenic Source of Infection
From the 954 HAI cases identified over the study period, 1131 pathogens were isolated and
reported, averaging 1.19 pathogens per infection. The most predominant pathogenic sources of
infection were Staphylococcus aureus (n=156, 13.79%), Escherichia coli (n=104, 9.20%),
Enterococcus sp (n=103, 9.11%), coagulase negative staphyloccocus (n=101, 8.93%), and
Pseudomonas aeruginosa (n=96, 8.49%). Figure 1 shows the top ten pathogens responsible for
HAI at the study site over the five-year period.
Antimicrobial-resistant pathogens accounted for 7.69% of all identified pathogens in this study.
Overall, 48.72% (n=76) of Staphylococcus aureus infections were oxacillin-resistant pathogens.
Nearly one-tenth (9.71%, n=10) of Enterococcus species were resistant to vancomycin. Of 96
For respiratory infections, the most predominant pathogens were Staphylococcus aureus
(17.69%, n=72), Pseudomonas aeruginosa (12.53%, n=51), and Enterobacter cloacae (8.11%,
n=33). A notable difference between device and non-device infections was seen in Escherichia
coli, which was responsible for nearly four times as many infections in non-device respiratory
infections (5.96%) compared to device infections (1.64%). For bloodstream infections, the most
predominant pathogens were coagulase negative staphylococcus (21.24%, n=55), Enterococcus
species (14.67%, n=38), and Staphylococcus aureus (11.20%, n=29). Coagulase negative
staphylococcus was the leading cause of bloodstream infection for both CLASBI and BSI. For
urinary tract infections, the most predominant pathogens were Escherichia coli (23.30%, n=48),
Enterococcus species (20.39%, n=42), and Candida species (10.68%, n=22). The pathogenic
trends for device and non-device urinary tract infections were largely similar, although Candida
was responsible for three times as many CAUTI compared to non-device UTI. For SSI, Staphylococcus aureus (19.79%, n=19), Escherichia coli (16.67%, n=16), and coagulase negative staphylococcus (12.50%, n=12) were the leading causing of infection. (Table 3)
Longitudinal Trends and Devices
The overall patient infection rate decreased over the five-year study period in all pediatric units. The greatest decrease was seen in the PICU, where incidence declined 42.00% from 2008 to
2012 (p<0.01). This was followed by the NCCC, nursing units and CICC.
As seen in Figure 2, over the five-year study period, the incidence of CLASBI and CAUTI decreased significantly. The incidence rate difference was -1.83 per 1,000 central-line days
(p=0.02) and -1.69 per 1,000-catheter days (p=0.02). The incidence of UTI also decreased by -0.45 infections per 1,000 patient days (p=0.05). The incidence of VAP (-3.11 per 1000 ventilator
days, p=0.11), NVAP (-0.11 infections per 1,000 patient days, p=0.12), and BSI (+0.10 infections per 1,000 patient days, p=0.24) did not change significantly over the same period. Over the
from 10.45% in 2008 to 40.00% in 2012 and the percentage of total pneumonia infections that
were non-device rated grew from 26.32% to 38.89%.
Discussion
This study is the largest and most comprehensive assessment of pediatric HAI in the published
literature. The study aimed to determine (1) differences in HAI incidence across all pediatric units
within a single hospital, (2) prevalence of pathogenic sources of HAI within a single hospital, and
(3) trends in pediatric HAI incidence over a 5-year time period for both device and
non-device-associated HAI. In analyzing five years of data from an academic hospital, we found that
pediatric HAI trends have largely aligned with trends seen in the adult population, with several
notable exceptions (detailed below).
As expected, given the different patient populations and disease burdens, we found that HAI
incidence varied substantially among the four pediatric hospital units. Considering all infections
together, the highest incidence per 1,000 patient days was seen in the PICU, followed by the
CICC, the NCCC, and the inpatients floors. This study supports previous research that found high
HAI rates within pediatric intensive care units.9,10 The PICU rate was nearly four-times higher than
the rate among the nursing units, and this is likely due to greater severity of disease and immune
deficiencies, and more frequent and lengthy device usage in the PICU. Per the data in Table 3,
compared to all other pediatric units, the PICU had the highest device utilization ratio (ratio of
device days to total patient days) for Foley-days, central line-days, and ventilator-days.Although
device-associated infections are decreasing, devices still carry a substantial risk for HAI; high
PICU infection rates are therefore unsurprising and attention to reducing these rates is needed.
The study further demonstrated that the top ten pathogenic sources of infection make up more
than three-fourths of all identified pathogens. Of the top four pathogens, three were Gram-positive
cocci (Staphylococcus aureus, Enterococcus sp, Staphylococcus coagulase negative) and one
(Pseudomonas aeruginosa, Candida sp, Clostridium difficile) and three were enteric pathogens (Enterobacter cloacae, Klebsiella pneumoniae, Serratia marcescens).
The study found that HAI declined among the study population in all four units over the five-year period. That CLASBI and CAUTI declined significantly is a promising finding, since critically ill
pediatric patients frequently require device intervention, and it suggests that such devices may
not increase the risk of infection as greatly as in the past. However, the lack of significant decline in VAP (which comprised nearly 9% of infections within the study population) indicates that a focus on infection prevention in the PICU and NCCC (the two units in which ventilators are
utilized) is needed. Although UTI rates declined significantly over the five-year period, incidence rates of non-device pneumonia and BSI have remained stagnant.
Compared to overall patient data from the CDC’s National Healthcare Safety Network (NHSN), which tracks device-associated HAI nationally, pathogenic sources of HAI among this pediatric population are quite similar.11 Although the rank order differs slightly, the top eight pathogens
among both patient populations are identical. However, patterns of antimicrobial-resistance differed.11 Compared with NHSN, the pediatric population at UNC had lower relative percentages
of overall drug-resistant pathogenic isolates (20% vs. 7.69%, respectively), oxacillin resistance among Staphylococcus aureus (56.2% vs. 48.7%, respectively), vancomycin resistance among
Enterococcus species (33.3% vs. 9.7%, respectively), and multi-drug resistance among Pseudomonas aeruginosa (>6.0% vs. 1.1% , respectively).11 Small numbers did not allow for
statistical analysis of multi-drug resistance by individual unit, but previous research has found minimal differences in resistance trends among hospital units.11
The five-year pediatric infection trends differ from previously published trends found among the
general patient population over the same time period within the same hospital.12 In both populations, HAI rates saw rapid declines from 2008-2012, driven by declines in
device-associated HAI, including VAP, while this infection did not decline significantly among pediatric
patients. Further research is needed to understand why the decline in VAP among adult patients
has not carried over to children. Additionally, the general population saw no significant changes in
infection rates for any non-device HAI, while the pediatric population saw a significant decline in
UTI. An exploration of interventions enacted among pediatric units during this timeframe may help
determine UTI-reduction strategies that can be applied to an adult patient population. For both
populations, device-associated infection incidence remains notably higher than incidence of
non-device infections, but this gap is narrowing as non-device-associated infections decline more rapidly.12
The study was strengthened by its large patient population, inclusion of data from all pediatric
units within a single hospital over five years, and use of surveillance data from trained infection
prevention specialists. The inclusion of nursing unit data here is notable because most literature
does not include a focus on these units, despite the presence of infection. Furthermore, the
inclusion of five years of data from a single location allows for a temporal analysis that cannot be
conducted from the CDC’s NHSN data alone. The inclusion of pathogenic data and breakout by
device and non-device HAI adds to the existing literature base around pediatric HAI. Study results
are limited in that they come from a single academic site and longitudinal data is over only five
years, resulting in some small sample sizes. Larger samples sizes would have allowed us to
assess specific infections by unit and year, and compare infection-specific longitudinal trends
among units.
As healthcare-associated infections persist and a focus on hospital epidemiology continues to
build, the need for pediatric-specific data and prevention plans will be of greater importance. The
CDC’s NHSN is the nation’s most widely used healthcare-associated infection tracking system
with data from more than 12,000 medical facilities, but pediatric reporting is very limited.13,14
Greater surveillance and reporting for pediatric patients, including specific breakout of
drug-resistant pathogenic isolates in children, would increase the sample size for analyses and allow
increased focus on non-device HAI among both pediatric and general patient populations.
Although device-associated HAI continue to comprise the majority of infections, this balance is
shifting as device-associated infections decline more rapidly and non-device infections remain
relatively stable.10 Declines in device-associated HAI in adult patients have been largely driven by the introduction of device-focused guidelines, bundles, and new technologies, as well as a focus
in traditional surveillance on device-associated infections, but it is unclear whether these are
sufficient for infection reduction in children as well.10,12, 15 Research on prevention of both device and non-device infections should be undertaken in pediatric and adult populations. Finally, there
is a need for pediatric-specific HAI definitions and quality control programs. Current definitions
from the CDC and NHSN are nearly identical for children and adults, despite known differences in
susceptibility and prevention.9,16 Existing quality control efforts such as the Surgical Care
Improvement Project, a national effort from the Joint Commission to reduce post-surgical
complications, apply only to patients 18 and older. Comparable programs are needed for pediatric
patients.
Increased funding and research are key when considering pediatric HAI, because the disease
burden is high while the knowledge base remains thin. Pediatric patients are a unique population,
and several of the findings in this study highlight differences between this population and a
general patient population in regard to longitudinal infection trends and patterns of pathogenic
resistance. Further reductions in pediatric HAI are undeniably important and – with targeted
research, increased knowledge and pediatric-specific guidelines – unquestionably possible.
Acknowledgments
I am grateful for the generous support of Dr. David J. Weber, Dr. Tamar Ringel-Kulka, Dr. William
Rutala, Dr. Emily Sickbert-Bennett, and Lauren M. DiBiase, from the Division of Infectious
Diseases, the Department of Hospital Epidemiology, and the Department of Maternal and Child
Health at the University of North Carolina, Chapel Hill, NC. Their feedback, analyses, and
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Tables
Table 1: Frequency of HAI by Type and Year, % (N), among pediatric inpatients at UNC Hospitals, 2008– 2012
2008 2009 2010 2011 2012 Total
CLABSI 25.42 (60) 18.81 (38) 21.47 (35) 13.27 (26) 11.46 (18) 18.55 (177)
BSI 2.97 (7) 2.48 (5) 4.91 (8) 3.06 (6) 7.64 (12) 3.98 (38)
VAP 11.86 (28) 9.41 (19) 5.52 (9) 8.67 (17) 7.01 (11) 8.81 (84)
NVAP 4.24 (10) 5.45 (11) 4.29 (7) 2.55 (5) 4.46 (7) 4.19 (40)
TRACHEOBRONCHITIS 13.14 (31) 18.32 (37) 22.70 (37) 20.92 (41) 16.56 (26) 18.03 (172)
OTHER RESPIRATORY
TRACT INFECTION 0.00 (0) 0.99 (2) 1.84 (3) 5.10 (10) 1.27 (2) 1.78 (17)
SSI - SUPERFICIAL 2.97 (7) 5.45 (11) 3.68 (6) 2.55 (5) 3.82 (6) 3.67 (35)
SSI - DEEP 0.42 (1) 0.99 (2) 1.84 (3) 3.06 (6) 1.91 (3) 1.57 (15)
SSI - ORGAN/SPACE 0.85 (2) 5.45 (11) 3.07 (5) 5.10 (10) 3.82 (6) 3.56 (34)
CAUTI 8.90 (21) 6.44 (13) 7.98 (13) 5.61 (11) 5.73 (9) 7.02 (67)
UTI 15.25 (36) 12.87 (26) 10.43 (17) 11.73 (23) 8.92 (14) 12.16 (116)
OTHER 13.98 (33) 13.37 (27) 12.27 (20) 18.37 (36) 27.39 (43) 16.67 (159)
Total 100% (236) 100% (202) 100% (163) 100% (196) 100% (157) 100% (954)
Table 2: Frequency (N) and infection rate of HAI by type and unit in pediatric inpatients at UNC Hospitals, 2008–2012
PICU CICC NCCC NU Total
CLABSI (N) 41 17 42 77 177
BSI (N) 4 4 23 7 38
VAP (N) 32 0 52 0 84
NVAP (N) 12 2 16 10 40
TRACHEOBRONCHITIS (N) 97 9 45 21 172
OTHER RESPIRATORY TRACT INFECTION
(N) 2 4 4 8 18
SSI – SUPERFICIAL (N) 5 2 11 17 35
SSI – DEEP (N) 1 0 1 13 15
SSI - ORGAN/SPACE (N) 11 1 8 14 34
CAUTI (N) 42 0 4 21 67
UTI (N) 25 5 54 32 116
OTHER (N) 26 16 59 57 158
Total (N) 298 60 319 277 954
Total Patient Days 26525 12107 82354 97915 218901
OVERALL PATIENT DAY INFECTION
RATE (PER 1,000 PATIENT DAYS) 11.23 4.96 3.87 2.83 4.36
BSI (PER 1,000 PATIENT DAYS) 0.15 0.33 0.28 0.07 0.17
NVAP (PER 1,000 PATIENT DAYS) 0.45 0.17 0.19 0.10 0.18
UTI PER (1,000 PATIENT DAYS) 0.94 0.41 0.66 0.33 0.53
Total Central Line Days 18037 5076 24455 43557 91125
CLABSI RATE (PER 1000 CENTRAL LINE
DAYS) 2.27 3.35 1.72 1.77 1.94
Total Foley Days 10481 * 1180 6002 17663
CAUTI RATE (PER 1000 FOLEY
CATHETER DAYS) 4.01 * 3.39 3.50 3.79
Total Ventilator Days 13991 * 12399 * 26390
VAP RATE (PER 1000 VENTILATOR DAYS) 2.29 * 4.19 * 3.18
*Device is not utilized within this unit
KEY: PICU, pediatric intensive care unit; CICC, children’s intermediate and cardiac care; NCCC, newborn critical care center, NU, nursing units; CLABSI, central line-associated bloodstream infections; BSI, bloodstream infections; VAP, ventilator-associated pneumonia; NVAP, non-ventilator-associated pneumonia, SSI, surgical site infections, CAUTI, catheter-associated urinary tract infection; UTI, urinary tract infections
Table 3: Pathogenic isolates by infection type and device association, % (n), in pediatric inpatients at UNC Hospitals, 2008–2012
Overall BSI UTI Respiratory SSI Other
Total Rank
Total %
(n) Device
Non-device Total Device
Non-device Total Device Non-device Total Total Total Staphylococcus
aureus* 1
13.79
(156) 9.35 (20) 20.00 (9) 11.20 (29) 1.33 (1) 3.82 (5) 2.91 (6) 17.21 (21) 17.89 (51) 17.69 (72)
19.79
(19) 18.40 (30) Escherichia
coli 2
9.20
(104) 4.67 (10) 11.11 (5) 5.79 (15) 25.33 (19) 22.14 (29) 23.30 (48) 1.64 (2) 5.96 (17) 4.67 (19)
16.67
(16) 3.68 (6) Enterococcus
sp* 3
9.11
(103) 16.36 (35) 6.67 (3) 14.67 (38) 13.33 (10) 24.43 (32) 20.39 (42) 1.64 (2) 2.46 (7) 2.21 (9) 7.29 (7) 3.68 (6) Staphylococcus
coagulase
negative 4 (101) 8.93 20.09 (43) 26.67 (12) 21.24 (55) 4.00 (3) 2.29 (3) 2.91 (6) 3.28 (4) 2.46 (7) 2.70 (11) 12.50 (12) 10.43 (17) Pseudomonas
aeruginosa* 5
8.49
(96) 6.54 (14) 0.00 (0) 5.41 (14) 6.67 (5) 6.87 (9) 6.80 (14) 12.30 (15) 12.63 (36) 12.53 (51) 7.29 (7) 6.13 (10) Enterobacter
cloacae 6
6.19
(70) 7.94 (17) 4.44 (2) 7.34 (19) 2.67 (2) 5.34 (7) 4.37 (9) 13.93 (17) 5.61 (16) 8.11 (33) 5.21 (5) 2.45 (4) Klebsiella
pneumoniae 7
5.92
(67) 7.01 (15) 4.44 (2) 6.56 (17) 8.00 (6) 8.4 (11) 8.25 (17) 5.74 (7) 6.67 (19) 6.39 (26) 6.25 (6) 0.61 (1)
Candida sp 8
5.39
(61) 9.35 (20) 2.22 (1) 8.11 (21) 18.67 (14) 6.11 (8) 10.68 (22) 1.64 (2) 1.75 (5) 1.72 (7) 3.13 (3) 4.91 (8) Clostridium
difficile 9
5.04
(57) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0) 0.00 (0)
34.97 (57) Serratia
marcescens 10
4.07
(46) 4.21 (9) 2.22 (1) 3.86 (10) 2. 67 (2) 0.76 (1) 1.46 (3) 7.38 (9) 6.67 (19) 6.88 (28) 3.13 (3) 1.23 (2)
Other**
23.87
(270) 14.49 (31) 22.22 (10) 15.83 (41) 17.33 (13) 19.85 (26) 18.93 (39) 35.25 (43) 37.89 (108) 37.10 (151)
18.75 (18) 13.50 (22) Total 100% (1131) 100% (214) 100% (45) 100% (259) 100% (75) 100% (131) 100% (206) 100% (122) 100% (285) 100% (407) 100% (96) 100% (163) *Includes antimicrobial-resistant pathogens
**Rhinovirus/Enterovirus, gram negative rods, Stenotrophomonas maltophilia, Klebsiella oxytoca, RSV, Proteus mirabilis, Enterobacter aerogenes, Beta streptocococcus group b, Citrobacter sp, Haemophilus influenzae, influenza, Acinetobacter, Torulopsis glabrata, Streptococcus viridans group, Streptococcus sp, Bacillus cereus, Parainfluenza, diphtheroids, Moraxella
catarrhalis, Klebsiella sp, rotavirus, Streptococcus agalactiae, parvovirus, Asperigillus fumagatus, Lactobacillus sp, Stomatococcus mucilaginosus, yeast, Acrhomobacter sp, Bacteriodes fragilis, Chlamydia trachomatis, Clostridium butyricum, Neisseria sp (saprophytic strain), Staphylococcus epidermis, Streptococcus mitis
Figures
Figure 1:
Figure 2: Incidence of device-associated and non-device-associated infections in pediatric inpatients with 5-year trend lines at University of North Carolina (UNC) Hospitals, 2008– 2012.
156
104 103 101 96
70
67 61 57
46 0 20 40 60 80 100 120 140 160 180 ST APH YL O C O C C U S AU R EU S ESC H ER IC H IA C O LI EN T ER O C O C C U S SP ST APH YL O C O C C U S C O AG U LASE N EG A T IVE PSEU D O MO N AS AER U G IN O SA EN T ER O BAC T ER C LO AC AE KL EBSI EL LA PN EU MO N IAE C AN D ID A SP C LO ST R ID IU M D IF F IC IL E SER R A T IA MAR C ESC EN S N u m b er o f id en ti fi ed p ath o g en ic is o la te s
Ten pathogenic sources of infection in pediatric inpatients at UNC Hospitals, 2008–2012
0.00 1.00 2.00 3.00 4.00 5.00 6.00
2008 2009 2010 2011 2012
In fe cti o n R ate p er 1 00 0 D ay s at R is k
Non-device-associated pneumonia and ventilator-associated pneumonia rates per 1,000 days at risk, pediatric inpatients,
UNC Hospitals, 2008–2012
NVAP PER 1,000 PATIENT DAYS
VAP RATE PER 1,000 VENTILATOR DAYS
0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50
2008 2009 2010 2011 2012
In fe cti o n R ate p er 1 ,0 00 D ay s at R is k
Non-device-associated bloodstream infection and central line– associated bloodstream infection rates per 1,000 days at risk,
pediatric inpatients, UNC Hospitals, 2008–2012
BSI PER 1,000 PATIENT DAYS
CLABSI RATE PER 1,000 CENTRAL LINE DAYS
0.00 1.00 2.00 3.00 4.00 5.00 6.00
2008 2009 2010 2011 2012
In fe cti o n R ate p er 1 ,0 00 D ay s at R is k
Non-device-associated urinary tract infection and catheter-associated urinary tract infection rates per 1,000 days at risk,
pediatric inpatients, UNC Hospitals, 2008–2012
UTI PER 1,000 PATIENT DAYS
CAUTI RATE PER 1,000 FOLEY CATHETER DAYS
p=0.02
p=0.05 p=0.02
