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2026, Number 2

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Rev Mex Pediatr 2026; 93 (2)

Epidemiology of healthcare-associated infections in a tertiary-level pediatric intensive care unit

García H, Mayo-Sánchez JI, Peregrino-Bejarano L

Language: Spanish
References: 33
Page: 64-72
PDF size: 870.36 Kb.


ABSTRACT

Introduction: patients admitted to a pediatric intensive care unit (PICU) are at high risk of developing healthcare-associated infections (HAIs) due to various risk factors. Objective: to describe the epidemiology of HAIs in the PICU of the Hospital de Pediatría del Centro Médico Nacional Siglo XXI, IMSS. Material and methods: this was an observational and prospective study conducted between November 2023 and October 2024. Patients < 17 years of age who met the Centers for Disease Control and Prevention criteria for the diagnosis of HAIs were included. The statistical analysis was descriptive. Results: a total of 167 HAIs were recorded in 145 patients, with an incidence of 28.2%. All patients had invasive devices, and 86.2% had comorbidities. Central line-associated bloodstream infection (CLABSI) was the most frequent HAI (53%). The main isolate was Klebsiella pneumoniae (28.1%), 61.7% of which were extended-spectrum beta-lactamase producers. The HAI lethality rate was 22.7%. Conclusions: the incidence of HAIs in the PICU was high. CLABSI were the most frequent. Gram-negative bacteria were the main causative agents and exhibited a high rate of antimicrobial resistance.


REFERENCES

  1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5): 309-332.

  2. Allegranzi B, Bagheri-Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011; 377(9761): 228-241.

  3. Hsu HE, Mathew R, Wang R, Broadwell C, Horan K, Jin R et al. Health care-associated infections among critically ill children in the US, 2013-2018. JAMA Pediatr. 2020; 174(12): 1176-1183.

  4. Zamudio-Lugo I, Espinosa-Vital GJ, Rodríguez-Sing R, Gómez-González CJ, Miranda-Novales MG. Infecciones nosocomiales. Tendencia durante 12 años en un hospital pediátrico. Rev Med Inst Mex Seguro Soc. 2014; 52 Suppl 2: S38-S42.

  5. Vilca-Yahuita J, Rodríguez-Auad JP, Philco-Lima P. Factores de riesgo asociados a infecciones intrahospitalarias en el paciente crítico. Rev Med La Paz. 2020; 26(1): 9-17.

  6. Zingg W, Hopkins S, Gayet-Ageron A, Holmes A, Sharland M, Suetens C et al. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis. 2017; 17(4): 381-389.

  7. Akinkugbe O, Cooke FJ, Pathan N. Healthcare-associated bacterial infections in the paediatric ICU. JAC Antimicrob Resist. 2020; 2(3): dlaa066.

  8. Jordan-Garcia I, Esteban-Torné E, Bustinza-Arriortua A, de Carlos-Vicente JC, García-Soler P, Concha-Torre JA et al. Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units. Enferm Infecc Microbiol Clin. 2016; 34(5): 286-292.

  9. Martins C, Lima D, Cortez-Ferreira M, Verdelho-Andrade J, Dias A. Healthcare-associated infections in pediatric patients: a decade of experience in an Intensive Care Unit. Acta Med Port. 2025; 38(1): 23-36.

  10. Wagh A, Sinha A. Prevention of healthcare-associated infections in paediatric intensive care unit. Childs Nerv Syst. 2018; 34(10): 1865-1870.

  11. Mohamed AA, Haftu H, Hadgu A, Seyoum D, Gebrekidan G, Ebrahim MM et al. Prevalence, clinical profile and risk factors of nosocomial infection in Ayder Pediatric Intensive Care Unit, Tigray, Ethiopia. Int J Gen Med. 2022; 15: 7145-7153.

  12. Martínez-Mena JM, Mateus-Caicedo AN. Infecciones asociadas a la atención de salud y mortalidad en pacientes pediátricos críticamente enfermos. Andes Pediatr. 2025; 96(4): 469-477.

  13. Barzallo T, Campoverde C. Prevalencia y factores asociados de las infecciones asociadas a la atención de la salud en el servicio de pediatría y unidad de cuidados intensivos pediátricos del Hospital Vicente Corral Moscoso. Rev Ecuat Pediatría. 2021; 22(1): 1-7.

  14. Lona-Reyes JC, Cruz-Chávez TA, Gallegos-Marín JA, Chávez-Vázquez AM, Alatorre-Rendón F, González-Carmona J et al. Infecciones relacionadas con la asistencia sanitaria en una unidad de cuidados intensivos pediátricos en México: epidemiología y factores asociados. Rev Argent Microbiol. 2025; 57(2): 136-141.

  15. Kannan A, Pratyusha K,·Thakur R,·Sahoo MR,·Jinda A. Infections in critically ill children. Indian J Pediatr. 2023; 90(3): 289-297.

  16. Andrade AP, Volpe AM, Barreto SC, Palazzi SMA, Mimica MJ. Hospital-acquired infections in children. A Latin American tertiary teaching hospital 5-year experience. Pediatr Infect Dis J. 2019; 38(1): e12-e14.

  17. Chetty T, Pillay A, Balakrishna Y, Reddy T, Goga A, Moore DP et al. Healthcare-associated infections drive antimicrobial prescribing in pediatric departments at three academic hospitals in South Africa. Pediatr Infect Dis J. 2023; 42(8): e283-e289.

  18. Avcu G, At?kan BY. Healthcare-associated infections at a tertiary level Pediatric Intensive Care Unit From Turkey. J Pediatr Res. 2021; 8(3): 246-250.

  19. Northway T, Langley JM, Skippen P. Health Care–Associated Infection in the Pediatric Intensive Care Unit: Epidemiology and Control–Keeping Patients Safe. Pediatric Critical Care. 2011: 1349-1363.

  20. Ulus A, Kara SS, Celik E. An evaluation of pediatric intensive care unit infection rates and various risk factors. Trends Pediatr. 2020; 1(2): 75-80.

  21. Elnasser Z, Obeidat H, Amarin Z. Device-related infections in a pediatric intensive care unit: the Jordan University of Science and Technology experience. Medicine (Baltimore). 2021; 100(43): e27651.

  22. Agüero MAM, Infante RKZ, Delgado LFE. Infecciones nosocomiales por bacterias gramnegativas y estadia prolongada en cuidados intensivos pediátricos. Rev Haban Cienc Med. 2021; 20(3): e3608.

  23. Centers for Disease Control and Prevention. About antimicrobial resistance. Disponible en: https://www.cdc.gov/antimicrobial-resistance/about/index.html

  24. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America guidance on the treatment of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis. 2021; 72(7): e169-e1823.

  25. Duan N, Sun L, Huang C, Li H, Cheng B. Microbial Distribution and Antibiotic Susceptibility of Bloodstream Infections in Different Intensive Care Units. Front Microbiol. 2021; 12: 792282.

  26. Wu X, Wang C, He L, Xu H, Jing C, Chen Y et al. Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016-2021. Front Cell Infect Microbiol. 2023; 13: 1102779.

  27. Willems J, Hermans E, Schelstraete P, Depuydt P, De Cock P. Optimizing the use of antibiotic agents in the Pediatric Intensive Care Unit: a narrative review. Paediatr Drugs. 2021; 23(1): 39-53.

  28. Cortegiani A, Antonelli M, Falcone M, Giarratano A, Girardis M, Leone M et al. Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement. J Anesth Analg Crit Care. 2023; 3(1): 11.

  29. CDC. National Healthcare Safety Network (NHSN). Patient safety component manual. January 2026. Disponible en: https://www.cdc.gov/nhsn/pdfs/pscmanual/pscmanual_current.pdf

  30. Lemiech-Mirowska E, Kiersnowska ZM, Micha?kiewicz M, Depta A, Marczak M. Nosocomial infections as one of the most important problems of healthcare system. Ann Agric Environ Med. 2021; 28(3): 361-366.

  31. Shi J, Sun T, Cui Y, Wang C, Wang F, Zhou Y et al. Multidrug resistant and extensively drug-resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit. BMC Infect Dis. 2020; 20(1): 597.

  32. Secretaria de Salud. Norma Oficial Mexicana NOM-045-SSA2-2005, para la vigilancia epidemiológica, prevención y control de las infecciones nosocomiales. Diario Oficial de la Federación del 20 de noviembre de 2009. Disponible en: https://www.pediatria.gob.mx/archivos/burbuja/13.1_NOM-045-SSA2-2005.pdf

  33. PROYECTO de Norma Oficial Mexicana PROY-NOM-045-SSA-2024, para la vigilancia epidemiológica, prevención y control de las infecciones asociadas a la atención de la salud. Disponible en: https://www.dof.gob.mx/nota_detalle_popup.php?codigo=5732885




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