title: Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey.
abstract: BACKGROUND
  In 2011-12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population.
  
  
  METHODS
  Point-prevalence surveys took place from May, 2011, to November, 2012, in 1149 hospitals in EU Member States, Iceland, Norway, and Croatia. Patients present on the ward at 0800 h on the day of the survey and who were not discharged at the time of the survey were included. Data were collected by locally trained health-care workers according to patient-based or unit-based protocols. We extracted data from the ECDC database for all paediatric patients (age 0-18 years). We report adjusted prevalence for health-care-associated infections by clustering at the hospital and country level. We also calculated risk factors for development of health-care-associated infections with use of a generalised linear mixed-effects model.
  
  
  RESULTS
  We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7-4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6-20·3) and neonatal intensive care units (10·7%, 9·0-12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]).
  
  
  CONCLUSIONS
  Infection prevention and control strategies in children should focus on prevention of bloodstream infections, particularly among neonates and infants.
  
  
  BACKGROUND
  None.
authors.affiliation: Imperial College London, London, UK; University of Geneva Hospitals, Geneva, Switzerland. Electronic address: walter.zingg@hcuge.ch.
authors.forename: Walter
authors.initials: W
authors.lastname: Zingg
authors.affiliation: Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
authors.affiliation: St George's University London, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Suetens
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000592:standards*; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000517:prevention & control; D012307:Risk Factors; D011795:Surveys and Questionnaires