title: Infection in prolonged pediatric critical illness: A prospective four-year study based on knowledge of the carrier state.
abstract: OBJECTIVE
  This study was performed to determine the rate, timing, and incidence density of infections occurring in a subgroup of patients requiring a prolonged stay in a regional pediatric intensive care unit.
  
  
  METHODS
  Prospective, observational cohort study over 4 yrs.
  
  
  METHODS
  This epidemiologic descriptive study was performed in a university hospital 20-bed pediatric intensive care unit.
  
  
  METHODS
  Critically ill children requiring > or = 4 days of intensive care.
  
  
  METHODS
  The microbial carrier state of the children was monitored by surveillance cultures of throat and rectum, obtained on admission and twice weekly afterward.
  
  
  RESULTS
  Data are presented on a total of 1,241 children, accounting for 1,443 admissions to the unit, corresponding to 18,203 patient days. The median pediatric index of mortality was 0.063 (interquartile range, 0.025-0.131), and the mortality rate in this subset of children was 9.6%. Five hundred twenty children had infections, an overall infection rate of 41.9% (520 of 1,241); 14.5% (180 of 1,241) of the children developed viral and 33.0% (410 of 1,241) developed bacterial/yeast infections. The incidence of bloodstream infection was 20.1 and lower airway infection 9.1 episodes per 1,000 patient days. We found that 13.3% of the children were infected with a bacterial/yeast microorganism acquired on the pediatric intensive care unit; 4.0% (50 of 1,241) of children developed infections due to resistant microorganisms. There were a total of 803 bacterial/yeast infectious episodes, of which 59.8% (480) were due to microorganisms imported in the patients' admission flora. These primary endogenous infections predominantly occurred within the first week of pediatric intensive care unit stay. The other 38.9% (312) were caused by microorganisms acquired on the pediatric intensive care unit. A total of 38 viral infections (24.5%) were acquired during pediatric intensive care unit stay.
  
  
  CONCLUSIONS
  Two thirds of all infections diagnosed in children with prolonged illness on pediatric intensive care unit were due to microorganisms present in the patients' admission flora.
authors.affiliation: Department of Pediatric Anaesthesia and Intensive Care, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Sarginson
authors.forename: N
authors.initials: N
authors.lastname: Taylor
authors.forename: N
authors.initials: N
authors.lastname: Reilly
authors.forename: P B
authors.initials: PB
authors.lastname: Baines
authors.forename: H K F
authors.initials: HK
authors.lastname: Van Saene
mesh_terms: D002353:Carrier State; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D019370:Observation; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies