title: Device-associated infections in the pediatric intensive care unit at the American University of Beirut Medical Center.
abstract: BACKGROUND
  Device-associated healthcare-associated infections (DA-HAIs) are the principal threat to patient safety in intensive care units (ICUs).  The primary objective of this study was to identify the most common DA-HAIs in the pediatric intensive care unit (PICU) at the American University of Beirut Medical Center (AUBMC). Length of stay (LOS) and mortality, antimicrobial resistance patterns, and suitability of empiric antibiotic choices for DA-HAIs according to the local resistance patterns were also studied.
  
  
  METHODS
  This was a retrospective study that included all patients admitted to the PICU at AUBMC between January 2007 and December 2011. All patients admitted to the PICU having a placed central line, an endotracheal tube, and/or a Foley catheter were included. Data was extracted from the patients' medical records through chart review. A total of 22 patients were identified with 25 central line-associated bloodstream infections (CLABSI), 25 ventilator-associated pneumonia (VAP), and 9 catheter-associated urinary tract infections (CAUTIs). The causing organisms, their resistance patterns, and the appropriateness of empiric antimicrobial therapy were reported.
  
  
  RESULTS
  Gram-negative pathogens were found in 53% of the DA-HAIs, Gram-positive ones in 27%, and fungal organisms in 20%. A total of 80% of K. pneumonia isolates were extended-spectrum beta-lactamases (ESBL) producers, and 30% of Pseudomonas isolates were multidrug resistant. No methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) were isolated. Based on culture results, the choice of empiric antimicrobial therapy was appropriate in 64% of the DA-HAIs.
  
  
  CONCLUSIONS
  After the care bundle approach is adopted in our PICU, DA-HAIs are expected to decrease further.
authors.affiliation: American University of Beirut Medical Center, Beirut, Lebanon. ai18@aub.edu.lb.
authors.forename: Ali
authors.initials: A
authors.lastname: Ismail
authors.forename: Abdul-Karim
authors.initials: AK
authors.lastname: El-Hage-Sleiman
authors.forename: Marianne
authors.initials: M
authors.lastname: Majdalani
authors.forename: Rima
authors.initials: R
authors.lastname: Hanna-Wakim
authors.forename: Souha
authors.initials: S
authors.lastname: Kanj
authors.forename: Rana
authors.initials: R
authors.lastname: Sharara-Chami
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D004864:Equipment and Supplies / Q000009:adverse effects*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007861:Lebanon / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D055815:Young Adult