title: Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length of Hospital Stay and Mortality Using a Multistate Analysis of Linked, Routinely Collected Data.
abstract: BACKGROUND
  Hospital-acquired bloodstream infection (HA-BSI) is associated with substantial morbidity, mortality, and healthcare costs in all patient populations. Young children have been shown to have a high rate of healthcare-associated infections compared with the adult population. We aimed to quantify the excess mortality and length of stay in pediatric patients from HA-BSI.
  
  
  METHODS
  We analyzed data collected retrospectively from a probabilistically linked national database of pediatric (aged 1 month-18 years) in-patients with a microbiologically confirmed HA-BSI in England between January and March 2009. A time-dependent Cox regression model was fit to determine the presence of any effect. Furthermore, a multistate model, adjusted for the time to onset of HA-BSI, was used to compare outcomes in patients with HA-BSI to those without HA-BSI. We further adjusted for patients' characteristics as recorded in hospital admission data.
  
  
  RESULTS
  The dataset comprised 333 605 patients, with 214 cases of HA-BSI. After adjustment for time to HA-BSI and comorbidities, the hazard for discharge (dead or alive) from hospital for patients with HA-BSI was 0.9 times (95% confidence interval [CI], .8-1.1) that of noninfected patients. Excess length of stay associated with all-cause HA-BSI was 1.6 days (95% CI, .2-3.0), although this duration varied by pathogen. Patients with HA-BSI had a 3.6 (95% CI, 1.3-10.4) times higher hazard for in-hospital death than noninfected patients.
  
  
  CONCLUSIONS
  Hospital-acquired bloodstream infection increased the length of stay and mortality of pediatric inpatients. The results of this study provide an evidence base to judge the health and economic impact of programs to prevent and control HA-BSI in children.
authors.affiliation: Public Health England, London, United Kingdom Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Green
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: K L
authors.initials: KL
authors.lastname: Henderson
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Muller-Pebody
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Thelwall
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: J V
authors.initials: JV
authors.lastname: Robotham
authors.affiliation: Pediatric Infectious Diseases Unit, St George's Hospital, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Freiburg Center for Data Analysis and Modeling, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wolkewitz
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: S R
authors.initials: SR
authors.lastname: Deeny
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004739:England / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010372:Pediatrics; D016896:Treatment Outcome
keywords: length of stay; multistate model; pediatric