InfecÃÃo hospitalar em unidade de terapia intensiva pediÃtrica / Healthcare-associated infection in a poaediatric intensive therapy unit




This thesis is presented in the form of three articles, the aim of which was to identify risk factors for healthcare-associated infection (HAI) in a paediatric intensive care unit (PICU) and estimate the effect of these factors on the time elapsed until the first episode of bloodstream infection, confirmed by laboratory exams (BSI-LCBI). The first article is a systematic review of observational studies on risk factors for HAI in PICUs, published from 1987 to 2006 and referenced in the MEDLINE, LILACS, Cochrane, BDENF and CAPES databases as well as authorsâ bibliographies. The second article is a cohort study on 870 children admitted in a clinical-surgical PICU, reference ICU for heart surgery, in a tertiary university hospital that treats patients form the Brazilian public healthcare system; intrinsic and extrinsic factors were investigated and measured until the occurrence of a first episode of HAI. The third article is a study on factors that influence the time elapsed until a first episode of BSI-LCBI. 1 - The systematic review identified 12 studies with different outcomes and the following risk factors for HAI without a specific localization: being a patient in the postoperative period; arriving from wards other than the emergency room; having a more severe condition upon admission according to the PRISM (Paediatric Risk of Mortality); a ratio of invasive procedures; use of antimicrobial agents; parenteral nutrition; remaining in the PICU for more days or more than 7 days; for BSI-LCBI: age, genetic syndrome, high number packed red blood cells transfusions; for BSI-LCBI in patients with central venous catheter: long duration of catheter use; duration of catheter use, life support with extracorporeal circulation, parenteral nutrition through a catheter, change of catheter with a guide wire and multiple central lines; for pneumonia: age ≤ two months, immunodeficiency, neuromuscular blockers and immunosuppressor drugs; for ventilator-associated pneumonia: genetic syndrome, transport outside of the PICU, reintubation, bronchoscopy and continuous enteral nutrition; for tracheitis: age ≤ 28 months, respiratory failure and head trauma. It was not possible to carry out a summarized measurement of the risk factors due to the absence of standardization in relation to the different types of exposure and in the way exposure was categorized for analysis. 2 - In the second article â a cohort study carried out over 18 months â the multivariate logistic regression analysis revealed the following risk factors for a first episode of HAI in the PICU (controlled for length of stay): age under two years; use of blood products, corticoids and gastric acid H2 blockers, each accounting for an approximately 30% fraction of risk for HAI among exposed individuals. Each day of use of mechanical ventilation was associated to a 16% increase in the risk of contracting HAI. 3 - In the third article, survival analysis was used to study factors that influence the time elapsed until BSI-LCBI. The following factors remained in the Cox multivariate model: age under two years, use of central venous catheter, having previous internment and days on ventilation. Identifying independent risk factors for the development of HAI in PICU contributes toward greater security for children who require intensive care. The control of adverse events stemming from care given to children is more feasible when the measures for achieving this control are founded on recommendations that are based on evidence produced in paediatric UTI


unidades de terapia intensiva pediÃtrica healthcare-associated infection estudos de coortes anÃlise de sobrevida systematic review cohort studies medicina infecÃÃo hospitalar revisÃo sistemÃtica survival analysis paediatric intensive care units

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