Abstract

Objectives. Our aims were (i) to describe trends in the epidemiology of Healthcare-associated Infections (HAIs) in paediatric/neonatal ICUs and (ii) to evaluate risk factors and impact of Multidrug-Resistance (MDR) in children admitted to ICUs. Design. Multicentre, retrospective, cohort study with a nested case-control study conducted between January 2010 and December 2014. Setting. Three tertiary-care paediatric hospitals in Italy and Brazil with a total of 97 ICU beds. Patients. Inclusion criteria were (i) admission to ICU during the study period (ii) age at onset <18 years and (iii) microbiologically-confirmed HAI. Results. 538 HAIs in 454 children were included. 93.3% of patients had comorbidities. Bloodstream infections (BSIs) were the leading pattern (45.4%). The cumulative incidence of HAI was 3.6/100 ICU-admission and the crude 30-day fatality rate was 5.7/1,000-admission. The most frequently isolated pathogens were Enterobacteriaceae, followed by Pseudomonas aeruginosa and Staphylococcus aureus.44% of isolates were MDR. Two multivariate logistic regressions were performed. Factors independently associated with an MDR -HAI were Country, previous antibiotics, transplantation, major surgery, and colonisation by an MDR strain. Factors independently associated with 30-day case-fatality were Country, previous transplantation, fungal infection, BSI, LRTI, and infection caused by MDR strains. Conclusions. Infection control and prevention should be a primary focus to limit the spread of MDR strains and improve the outcome of hospitalised patients. Targeted surveillance programmes collecting neonatal and paediatric HAI/BSI data and outcomes would allow global benchmarking between centres. The next step is to identify simple methods to monitor key HAIs and integrate these into affordable intervention programmes.