Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes

Costa, Patrícia de Oliveira; Atta, Elias Hallack; Silva, André Ricardo Araújo da

doi:10.1016/j.jped.2014.11.009

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • J. Pediatr. (Rio J.) 91 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.jped.2014.11.009 copy

Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes^☆ 2 ☆ Please cite this article as: de Oliveira Costa P, Atta EH, da Silva AR. Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes. J Pediatr (Rio J). 2015;91:435-41

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU).

METHODS:

Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality.

RESULTS:

Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy.

CONCLUSIONS:

Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.

Keywords:
Cancer; Pediatric intensive care unit; Infection; Multidrug-resistant gram-negative; Risk factor; Outcome

	MDR-GNB n = 47 n (%)	Non-MDR-GNB n = 54 n (%)	OR	95% CI	p-Value
Male, gender	25 (53.2%)	27 (50.0%)	1.360	0.519–2.486	0.749
Age (years)^a	7 (0.2–18)	6.5 (2–17)	0.650	0.948–1.089	0.650
Hematologic disease	18 (38.3%)	6 (11.1%)	4.966	1.768–13.944	0.002
Cancer status (controlled/remission)	7 (14.9%)	13 (24.1%)	0.552	0.200–1.526	0.252
Central venous catheter	45 (95.7%)	48 (88.9%)	2.812	0.540–14.662	0.220
Neutropenia^b	34 (72.3%)	40 (74.1%)	1.092	0.452–2.640	0.844
Duration of neutropenia ≥3 days	13 (27.7%)	5 (9.3%)	3.747	1.22–11.488	0.021
Previous antibiotic therapy^c	46 (97.9%)	43 (79.6%)	11.760	1.457–95.035	0.021
Healthcare-associated infection (from ward and PICU)	46 (97.9%)	36 (66.6%)	23.000	2.930–180.523	0.003
Use of corticosteroids^c	42 (89.4%)	50 (92.6%)	0.672	0.170–2.664	0.572
Length of stay before ICU^a	3 (0–89)	1 (0–56)	1.006	0.978–1.034	0.679
Length of ICU stay >3 days	30 (63.8%)	20 (37%)	3.000	1.332–6.756	0.008
Chemotherapy/radiation therapy^c	33 (70.2%)	39 (72.2%)	0.907	0.382–2.150	0.824
Previous episode of Pseudomonas aeruginosa infection	7 (14.9%)	10 (18.5%)	0.770	0.268–2.215	0.628

	MDR-GNB n = 47 n (%)	Non-MDR-GNB n = 54 n (%)	OR	95% CI	p-Value
Healthcare-associated infection	46 (97.9%)	36 (66.6%)	18.360	1.778–189.560	0.015
Hematologic diseases	18 (38.3%)	6 (11.1%)	5.262	1.282–21.594	0.021
Length of neutropenia ≥3 days	13 (27.7%)	5 (9.3%)	2.802	0.602–13.035	0.189
Length of ICU stay >3 days	30 (63.8%)	20 (37%)	1.680	0.613–4.606	0.313
Previous antibiotic therapy^a	46 (97.9%)	43 (79.6%)	3.082	0.296–32.049	0.346

	MDR-GNB n = 47 n (%)	Non-MDR-GNB n = 54 n (%)	p-Value
Appropriate initial antibiotic treatment	12 (25.5%)	34 (63.0%)	<0.001
Definitive inadequate antimicrobial treatment	5 (10.6%)	0 (0%)	0.014
Length of time to initiate adequate antibiotic therapy (days)^a	2 (0–10)	0 (0–7)	<0.001
Duration of appropriate antibiotic use (days)^a	10.5 (5–22)	10 (2–23)	0.608
7-day mortality	5 (10.6%)	3 (5.6%)	0.345
30-day mortality	12 (25.5%)	9 (16.7%)	0.273

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail: patyocosta29@bol.com.br(P. de Oliveira Costa).