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Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Published online by Cambridge University Press:  18 December 2017

Jason G. Lake ,
Lindsey M. Weiner ,
Aaron M. Milstone ,
Lisa Saiman ,
Shelley S. Magill  and
Isaac See
Jason G. Lake*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Lindsey M. Weiner
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Aaron M. Milstone
Affiliation:
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health Baltimore, Maryland Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa Saiman
Affiliation:
Department of Pediatrics, Columbia University, New York, New York Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Isaac See
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Jason Lake, MD, MPH, Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, Missouri 63110 (jasonlake@wustl.edu).
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Abstract

OBJECTIVE

To describe pathogen distribution and antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) from pediatric locations during 2011–2014.

METHODS

Device-associated infection data were analyzed for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI). Pooled mean percentage resistance was calculated for a variety of pathogen-antimicrobial resistance pattern combinations and was stratified by location for device-associated infections (neonatal intensive care units [NICUs], pediatric intensive care units [PICUs], pediatric oncology and pediatric wards) and by surgery type for SSIs.

RESULTS

From 2011 to 2014, 1,003 hospitals reported 20,390 pediatric HAIs and 22,323 associated pathogens to the NHSN. Among all HAIs, the following pathogens accounted for more than 60% of those reported: Staphylococcus aureus (17%), coagulase-negative staphylococci (17%), Escherichia coli (11%), Klebsiella pneumoniae and/or oxytoca (9%), and Enterococcus faecalis (8%). Among device-associated infections, resistance was generally lower in NICUs than in other locations. For several pathogens, resistance was greater in pediatric wards than in PICUs. The proportion of organisms resistant to carbapenems was low overall but reached approximately 20% for Pseudomonas aeruginosa from CLABSIs and CAUTIs in some locations. Among SSIs, antimicrobial resistance patterns were similar across surgical procedure types for most pathogens.

CONCLUSION

This report is the first pediatric-specific description of antimicrobial resistance data reported to the NHSN. Reporting of pediatric-specific HAIs and antimicrobial resistance data will help identify priority targets for infection control and antimicrobial stewardship activities in facilities that provide care for children.

Infect Control Hosp Epidemiol 2018;39:1–11

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 1 - 11
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. A select few pathogens and associated antimicrobial resistance patterns from central line-associated bloodstream infections and catheter-associated urinary tract infections were presented at IDWeek 2016 on October 29, 2016, in New Orleans, Louisiana (Abstract 1779).

References

REFERENCES

1. Mauldin, PD, Salgado, CD, Hansen, IS, Durup, DT, Bosso, JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother 2010;54:109–115.Google Scholar
2. Eber, MR, Laxminarayan, R, Perencevich, EN, Malani, A. Clinical and economic outcomes attributable to health care–associated sepsis and pneumonia. Arch Intern Med 2010;170:347–353.Google Scholar
3. Polin, RA, Denson, S, Brady, MT, et al. Epidemiology and diagnosis of health care–associated infections in the NICU. Pediatrics 2012;129:e1104–e1109.CrossRefGoogle ScholarPubMed
4. Stone, PW. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res 2009;9:417–422.Google Scholar
5. Stone, PW, Hedblom, EC, Murphy, DM, Miller, SB. The economic impact of infection control: making the business case for increased infection control resources. Am J Infect Control 2005;33:542–547.CrossRefGoogle ScholarPubMed
6. Patrick, SW, Kawai, AT, Kleinman, K, et al. Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics 2014;134:705–712.Google Scholar
7. Haeusler, GM, Mechinaud, F, Daley, AJ, et al. Antibiotic-resistant gram-negative bacteremia in pediatric oncology patients—risk factors and outcomes. Pediatr Infect Dis J 2013;32:723–726.CrossRefGoogle ScholarPubMed
8. Siegel, JS. Pediatric Infection Prevention and Control. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Disease. 4th ed.. Philadelphia, PA: Elsevier Health Sciences; 2012. Pp. 9–24.Google Scholar
9. Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2013, Device-associated module. Am J Infect Control 2015;43:206–221.CrossRefGoogle Scholar
10. Milstone, AM, Bryant, KA, Huskins, WC, Zerr, DM. The past, present, and future of healthcare-associated infection prevention in pediatrics: multidrug-resistant organisms. Infect Control Hosp Epidemiol 2010;31:S18–S21.Google Scholar
11. Hidron, AI, Edwards, JR, Patel, J, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
12. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.Google Scholar
13. Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle Scholar
14. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central line-associated Bloodstream Infection). Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Updated January 2016. Accessed January 10, 2017.Google Scholar
15. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf. Updated January 2016. Accessed January 10, 2017.Google Scholar
16. Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) events. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf. Updated January 2016. Accessed January 10, 2017.Google Scholar
17. Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Updated January 2016. Accessed January 10, 2017.Google Scholar
18. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Updated January 2017. Accessed May 1, 2017.Google Scholar
19. Centers for Medicare and Medicaid Services (CMS), HHS. Hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2012 rates; final rule. Fed Regist 2011;76:51476–51846.Google Scholar
20. Centers for Medicare and Medicaid Services (CMS), HHS. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric Units; Final Rule. Fed Regist 2011;76:47836–47915.Google Scholar
21. Magiorakos, AP, Srinivasan, A, Carey, R, et al. Multidrug‐resistant, extensively drug‐resistant and pandrug‐resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infecti 2012;18:268–281.CrossRefGoogle ScholarPubMed
22. Balkhy, HH, Zingg, W. Update on infection control challenges in special pediatric populations. Curr Opin Infect Dis 2014;27:370–378.Google Scholar
23. Bender, JM, Virgallito, M, Newland, JG, et al. Infection prevention and control practices in children’s hospitals. Infect Control Hosp Epidemiol 2015;36:597–600.CrossRefGoogle ScholarPubMed
24. Cocoros, NM, Kleinman, K, Priebe, GP, et al. Ventilator-associated events in neonates and children—a new paradigm. Crit Care Med 2016;44:14–22.CrossRefGoogle ScholarPubMed
25. Koutlakis-Barron, I, Hayden, T. Essentials of infection prevention in the pediatric population. Int J Pediatr Adolesc Med 2016;3:143–152.CrossRefGoogle ScholarPubMed
26. Sandora, TJ. Prevention of healthcare-associated infections in children: new strategies and success stories. Curr Opin Infect Dis 2010;23:300–305.Google Scholar
27. Patel, SJ, Saiman, L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol 2010;37:547–563.Google Scholar
28. Hocevar, SN, Edwards, JR, Horan, TC, Morrell, GC, Iwamoto, M, Lessa, FC. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2012;33:1200–1206.CrossRefGoogle Scholar
29. Centers for Disease Control and Prevention. Vital signs: carbapenem-resistant Enterobacteriaceae. Morb Mortal Wkly Rep 2013;62:165–170.Google Scholar
30. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.Google Scholar
31. McGrath, EJ, Asmar, BI. Nosocomial infections and multidrug-resistant bacterial organisms in the pediatric intensive care unit. Indian J Pediatr 2011;78:176–184.Google Scholar
32. Perez, F, Hujer, AM, Hujer, KM, Decker, BK, Rather, PN, Bonomo, RA. Global challenge of multidrug-resistant Acinetobacter baumannii . Antimicrob Agents Chemother 2007;51:3471–3484.Google Scholar
33. Logan, LK. Carbapenem-resistant Enterobacteriaceae: an emerging problem in children. Clin Infect Dis 2012;55:852–859.Google Scholar
34. Drews, BB, Sanghavi, R, Siegel, JD, Metcalf, P, Mittal, NK. Characteristics of catheter‐related bloodstream infections in children with intestinal failure: implications for clinical management. Gastroenterol Nurs 2009;32:385–390.CrossRefGoogle ScholarPubMed
35. Miko, BA, Kamath, SS, Cohen, BA, Jeon, C, Jia, H, Larson, EL. Epidemiologic associations between short-bowel syndrome and bloodstream infection among hospitalized children. J Pediatric Infect Dis Soc 2015;4:192–197.CrossRefGoogle ScholarPubMed
36. Moukarzel, AA, Haddad, I, Ament, ME, et al. 230 patient years of experience with home long-term parenteral nutrition in childhood: natural history and life of central venous catheters. J Pediatr Surg 1994;29:1323–1327.CrossRefGoogle ScholarPubMed
37. Terra, RM, Plopper, C, Waitzberg, DL, et al. Remaining small bowel length: association with catheter sepsis in patients receiving home total parenteral nutrition: evidence of bacterial translocation. World J Surg 2000;24:1537–1541.Google Scholar
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