Pediatric mortality due to nosocomial infection: a critical approach.
Nosocomial infection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomial infection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomial infection and mortality and pediatrics/neonate/ newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomial infection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE) II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomial infection can be reduced and health care quality improved in pediatric hospitals.
Lopes
Julia Marcia Maluf
JM
Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, 190/Sala 4061, Santa Efigênia, Belo Horizonte, MG, Brazil. JuliaLopes@vsnet.com.br
Goulart
Eugenio Marcos Andrade
EM
Starling
Carlos Ernesto Ferreira
CE
D018806:APACHE; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors
D000890:Anti-Infective Agents