Burden, spectrum, and impact of healthcare-associated infection at a South African children's hospital.

Abstract

Background: In most African countries the prevalence and effects of paediatric healthcare-associated infection (HCAI) and human immunodeficiency virus (HIV) infection are unknown.

Aim: To investigate the burden, spectrum, risk factors, and impact of paediatric HCAI by prospective clinical surveillance at a South African referral hospital.

Methods: Continuous prospective clinical and laboratory HCAI surveillance using Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) definitions was conducted at Tygerberg Children's Hospital, South Africa, from May 1^st to October 31^st in 2014 and 2015. Risk factors for HCAI and associated mortality were analysed with multivariate logistic regression; excess length of stay was estimated using a confounder and time-matching approach.

Findings: HCAI incidence density was 31.1 per 1000 patient-days (95% CI: 28.2-34.2); hospital-acquired pneumonia (185/417; 44%), urinary tract infection (UTI) (45/417; 11%), bloodstream infection (BSI) (41/417; 10%), and surgical site infection (21/417; 5%) predominated. Device-associated HCAI incidence in the paediatric intensive care unit (PICU) was high: 15.9, 12.9 and 16 per 1000 device-days for ventilator-associated pneumonia, central line-associated BSI and catheter-associated UTI, respectively. HCAI was significantly associated with PICU stay (odds ratio: 2.0), malnutrition (1.6), HIV infection (1.7), HIV exposure (1.6), McCabe score 'fatal' (2.0), comorbidities (1.6), indwelling devices (1.9), blood transfusion (2.5), and transfer in (1.4). Two-thirds of paediatric deaths were HCAI-associated, occurring at a median of four days from HCAI onset with significantly higher crude mortality for HCAI-affected vs HCAI-unaffected hospitalizations [24/325 (7.4%) vs 12/1022 (1.2%); P<0.001]. HCAI resulted in US$371,887 direct costs with an additional 2275 hospitalization days, 2365 antimicrobial days, and 3575 laboratory investigations.

Conclusion: HCAI was frequent with significant morbidity, mortality, and healthcare costs. Establishment of HCAI surveillance and prevention programmes for African children is a public health priority.