Transfusion of leukocyte-depleted red blood cells is not a risk factor for nosocomial infections in critically ill children.
OBJECTIVE
Transfusion of red blood cells is increasingly linked with adverse outcomes in critically ill children. We tested the hypothesis that leukocyte-depleted red blood cell transfusions were independently associated with increased development of bloodstream infections, ventilator-associated pneumonias, or urinary tract infections.


METHODS
Historical, descriptive cohort study.


METHODS
Single-center, mixed medical-surgical, closed nine-bed pediatric intensive care unit of a tertiary university hospital.


METHODS
All children <18 yrs of age consecutively admitted to the pediatric intensive care unit during a 3-yr period (January 1, 2005, to December 31, 2007).


METHODS
None.


RESULTS
One thousand one hundred twenty-three patients were admitted, of whom 503 (44.8%) were admitted for >48 hrs. Sixty-five (12.9%) had a nosocomial infection (incidence 19.3 per 1,000 pediatric intensive care unit admissions per year). Patients with a nosocomial infection were significantly more often male (72.3% vs. 27.7%, p = .033), had a higher Pediatric Risk of Mortality II score (median 19.1 [range, 6-44] vs. 18.0 [range, 2-39], p = .023), were more often ventilated (95.4% vs. 80.1%, p = .003), and received more often red blood cell transfusions (55.4% vs. 40.2%, p = .021). Multivariate logistic regression analysis showed that male gender (odds ratio, 2.07; 95% confidence interval, 1.14-3.76), presence of an indwelling central venous catheter (odds ratio, 2.41; 95% confidence interval, 1.29-4.48), and simultaneous use of more than one type of antimicrobial drug were independently associated with the development of nosocomial infections. Red blood cell transfusion was discarded as a predictor.


CONCLUSIONS
Transfusion of leukocyte-depleted red blood cells was not independently associated with the development of nosocomial infections in a heterogeneous group of critically ill children.
Department of Paediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
Judith
J
van der Wal
Marc
M
van Heerde
Dick G
DG
Markhorst
Martin C J
MC
Kneyber
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors