Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise: A Post Hoc Analysis of the CRISIS Trial

Joseph A. Carcillo*, J. Michael Dean, Richard Holubkov, John Berger, Kathleen L. Meert, Kanwaljeet J S Anand, Jerry Zimmerman, Christopher J. Newth, Rick Harrison, Jeri Burr, Douglas F. Willson, Carol Nicholson, Michael J. Bell, Robert A. Berg, Thomas P. Shanley, Sabrina M. Heidemann, Heidi Dalton, Tammara L. Jenkins, Allan Doctor, Angie Webster

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results: There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (P < 0.05). In multivariable analysis, only increasing age, cardiac arrest and existing lymphopenia remained significant admission risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). Conclusions: These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

Original languageEnglish (US)
Pages (from-to)1182-1186
Number of pages5
JournalPediatric Infectious Disease Journal
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Cross Infection
Critical Illness
Pediatric Intensive Care Units
Lymphopenia
Heart Arrest
Wounds and Injuries
Random Allocation
Population
Sepsis
Databases
Prospective Studies
Pediatrics
Mortality

Keywords

  • immune competent host
  • nosocomial infection
  • pediatric intensive care unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Carcillo, Joseph A. ; Dean, J. Michael ; Holubkov, Richard ; Berger, John ; Meert, Kathleen L. ; Anand, Kanwaljeet J S ; Zimmerman, Jerry ; Newth, Christopher J. ; Harrison, Rick ; Burr, Jeri ; Willson, Douglas F. ; Nicholson, Carol ; Bell, Michael J. ; Berg, Robert A. ; Shanley, Thomas P. ; Heidemann, Sabrina M. ; Dalton, Heidi ; Jenkins, Tammara L. ; Doctor, Allan ; Webster, Angie. / Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise : A Post Hoc Analysis of the CRISIS Trial. In: Pediatric Infectious Disease Journal. 2016 ; Vol. 35, No. 11. pp. 1182-1186.
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abstract = "Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results: There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35{\%}) developed nosocomial infection, and 164 (65{\%}) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (P < 0.05). In multivariable analysis, only increasing age, cardiac arrest and existing lymphopenia remained significant admission risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). Conclusions: These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.",
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author = "Carcillo, {Joseph A.} and Dean, {J. Michael} and Richard Holubkov and John Berger and Meert, {Kathleen L.} and Anand, {Kanwaljeet J S} and Jerry Zimmerman and Newth, {Christopher J.} and Rick Harrison and Jeri Burr and Willson, {Douglas F.} and Carol Nicholson and Bell, {Michael J.} and Berg, {Robert A.} and Shanley, {Thomas P.} and Heidemann, {Sabrina M.} and Heidi Dalton and Jenkins, {Tammara L.} and Allan Doctor and Angie Webster",
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Carcillo, JA, Dean, JM, Holubkov, R, Berger, J, Meert, KL, Anand, KJS, Zimmerman, J, Newth, CJ, Harrison, R, Burr, J, Willson, DF, Nicholson, C, Bell, MJ, Berg, RA, Shanley, TP, Heidemann, SM, Dalton, H, Jenkins, TL, Doctor, A & Webster, A 2016, 'Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise: A Post Hoc Analysis of the CRISIS Trial', Pediatric Infectious Disease Journal, vol. 35, no. 11, pp. 1182-1186. https://doi.org/10.1097/INF.0000000000001286

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise : A Post Hoc Analysis of the CRISIS Trial. / Carcillo, Joseph A.; Dean, J. Michael; Holubkov, Richard; Berger, John; Meert, Kathleen L.; Anand, Kanwaljeet J S; Zimmerman, Jerry; Newth, Christopher J.; Harrison, Rick; Burr, Jeri; Willson, Douglas F.; Nicholson, Carol; Bell, Michael J.; Berg, Robert A.; Shanley, Thomas P.; Heidemann, Sabrina M.; Dalton, Heidi; Jenkins, Tammara L.; Doctor, Allan; Webster, Angie.

In: Pediatric Infectious Disease Journal, Vol. 35, No. 11, 01.11.2016, p. 1182-1186.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

T2 - A Post Hoc Analysis of the CRISIS Trial

AU - Carcillo, Joseph A.

AU - Dean, J. Michael

AU - Holubkov, Richard

AU - Berger, John

AU - Meert, Kathleen L.

AU - Anand, Kanwaljeet J S

AU - Zimmerman, Jerry

AU - Newth, Christopher J.

AU - Harrison, Rick

AU - Burr, Jeri

AU - Willson, Douglas F.

AU - Nicholson, Carol

AU - Bell, Michael J.

AU - Berg, Robert A.

AU - Shanley, Thomas P.

AU - Heidemann, Sabrina M.

AU - Dalton, Heidi

AU - Jenkins, Tammara L.

AU - Doctor, Allan

AU - Webster, Angie

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results: There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (P < 0.05). In multivariable analysis, only increasing age, cardiac arrest and existing lymphopenia remained significant admission risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). Conclusions: These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

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KW - immune competent host

KW - nosocomial infection

KW - pediatric intensive care unit

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