title: Are red blood cell transfusions associated with nosocomial infections in pediatric intensive care units?
abstract: OBJECTIVE
  To determine whether red blood cell transfusion is similarly associated with nosocomial infections in pediatric intensive care unit patients and whether reduced lymphocyte numbers is a possible mechanism. In adult studies, red blood cell transfusions are associated with nosocomial infections.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Single-center, mixed medical-surgical, closed pediatric intensive care unit of a tertiary university-affiliated children's hospital.
  
  
  METHODS
  All patients < or = 18 yrs old admitted to the pediatric intensive care unit during a 6-month period from January 1 to July 3, 2005.
  
  
  METHODS
  None.
  
  
  RESULTS
  Nosocomial infections (respiratory, urinary tract, and bloodstream infections) were the primary outcome measure and were defined as post transfusion if occurring within 14 days after red blood cell transfusion. Of the 209 subjects enrolled, 32 (15%) acquired nosocomial infections and 45 (22%) received red blood cell transfusions. Patients with versus without nosocomial infections had received red blood cell transfusions significantly more often (odds ratio, 18.0; 95% confidence interval, 7.6-45.9; p < .001). In a dose-dependence analysis, we found that patients receiving > or = 3 red blood cell transfusions had a similar prevalence of nosocomial infections compared with those receiving one to two red blood cell transfusions (61% vs. 44%, p = .365), but greater mortality (22% vs. 0%, p = .04). In a multiple logistic regression analysis controlling for gender, age, pediatric intensive care unit length of stay, presence of an invasive catheter, mechanical ventilation, and surgery, red blood cell transfusion remained independently associated with risk of nosocomial infection (odds ratio, 3.73; 95% confidence interval, 1.19-11.85, p = .023). Transfused subjects had lower absolute lymphocyte counts compared with nontransfused subjects (1605 vs. 2054/microL, p = .041), but similar total white blood cell counts (10.4 vs. 11.4 x 10/microL, p = .52).
  
  
  CONCLUSIONS
  Red blood cell transfusion in pediatric intensive care unit patients is associated with an increased risk of nosocomial infections.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Malik
authors.initials: M
authors.lastname: White
authors.forename: Joel
authors.initials: J
authors.lastname: Barron
authors.forename: Jeff
authors.initials: J
authors.lastname: Gornbein
authors.forename: James A
authors.initials: JA
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult