Factors associated with time to acquisition of bloodstream infection in a pediatric intensive care unit.
OBJECTIVE
To evaluate the risk factors that influence time to acquisition of a laboratory-confirmed bloodstream infection (LCBI).


METHODS
Prospective cohort study with an 18-month follow-up.


METHODS
A 16-bed medical and/or surgical pediatric intensive care unit that cares for patients of the Brazilian Public Health System exclusively.


METHODS
We included children from 0 to 18 years old who were represented by 875 consecutive admissions to the pediatric intensive care unit from January 1, 2005, through June 30, 2006. The children from all but 5 (0.6%) of the admissions were followed up until discharge or death. The majority (506 [58.2%]) were hospitalized for surgical pathology, and 254 (29.2%) underwent heart surgery.


METHODS
We used a standardized questionnaire and data collection from daily charts. Information on risk factors was collected before the onset of first LCBI. Survival analysis was performed using the Kaplan-Meier method. The effect of the variables on the risk of LCBI each day was estimated through a Cox model fitting.


RESULTS
Fifty-seven children (6.6%) developed an LCBI, 54 (94.7%) of whom made use of a central venous catheter. LCBI incidence was 11.27 episodes/1,000 patient-days and 17.92 episodes/1,000 patient-days when associated with a central venous catheter. Factors associated with time to the first LCBI in the Cox model were age less than 2 years (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.02-3.89), malnutrition (HR, 1.74; 95% CI, 1.01-3.00), use of a central venous catheter (HR, 4.36; 95% CI, 1.30-14.64), use of antibiotics before admission (HR, 0.58; 95% CI, 0.33-0.98), and use of transfused blood products (HR, 0.40; 95% CI, 0.22-0.74).


CONCLUSIONS
Factors associated with time to acquisition of LCBI were age less than 2 years, weight-for-age z score less than -2, and the use of a central venous catheter. Therefore, intensification of LCBI prevention efforts in patients with these characteristics is fundamental.
de Mello
Maria Júlia Gonçalves
MJ
Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil. juliagmello@imip.org.br
de Albuquerque
Maria de Fátima Pessoa Militão
Mde F
Ximenes
Ricardo Arraes de Alencar
RA
Lacerda
Heloísa Ramos
HR
Ferraz
Eduardo Jaime Seara
EJ
Byington
Rita
R
Barbosa
Maria Tereza Serrano
MT
D000293:Adolescent; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors