TY - JOUR
T1 - Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise
T2 - A Post Hoc Analysis of the CRISIS Trial
AU - Carcillo, Joseph A.
AU - Dean, J. Michael
AU - Holubkov, Richard
AU - Berger, John
AU - Meert, Kathleen L.
AU - Anand, Kanwaljeet J.S.
AU - Zimmerman, Jerry
AU - Newth, Christopher J.
AU - Harrison, Rick
AU - Burr, Jeri
AU - Willson, Douglas F.
AU - Nicholson, Carol
AU - Bell, Michael J.
AU - Berg, Robert A.
AU - Shanley, Thomas P.
AU - Heidemann, Sabrina M.
AU - Dalton, Heidi
AU - Jenkins, Tammara L.
AU - Doctor, Allan
AU - Webster, Angie
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results: There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (P < 0.05). In multivariable analysis, only increasing age, cardiac arrest and existing lymphopenia remained significant admission risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). Conclusions: These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.
AB - Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results: There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (P < 0.05). In multivariable analysis, only increasing age, cardiac arrest and existing lymphopenia remained significant admission risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). Conclusions: These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.
KW - immune competent host
KW - nosocomial infection
KW - pediatric intensive care unit
UR - http://www.scopus.com/inward/record.url?scp=84977100891&partnerID=8YFLogxK
U2 - 10.1097/INF.0000000000001286
DO - 10.1097/INF.0000000000001286
M3 - Article
C2 - 27753764
AN - SCOPUS:84977100891
SN - 0891-3668
VL - 35
SP - 1182
EP - 1186
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 11
ER -