Browsing by Author "Ramsunder, Prishani"

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    Epidemiology of healthcare-associated bloodstream infections in the paediatric intensive care unit
    (Stellenbosch : Stellenbosch University, 2021-12) Ramsunder, Prishani; Appel, Ilse; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Abstract Background: Limited data is available from African country paediatric intensive care units (PICU) on the burden, pathogen profile and outcome of healthcare-associated bloodstream infections (HA-BSI). Methods: A retrospective record review was conducted in the PICU at Tygerberg Hospital, South Africa between January 2015 and December 2017. Data on infection rate, pathogen profile, patient demographics and outcome were collected for all children diagnosed with HA-BSI (a laboratory-confirmed BSI arising > 48 hours after admission to the PICU). Results: Over the 3-year study period 2643 patients were admitted to PICU and 1116 blood cultures were collected. The blood culture pathogen yield was 7.5% (84/1116) comprising 27 community-acquired BSI (32.1%), 11 HA-BSI acquired prior to PICU admission (13.1%) and 46 HA-BSI acquired in PICU (54.8%). The incidence rate of HA-BSI acquired in the PICU was 4.7/1000 patient days. No source of infection was identified for 62.5% of HA-BSI cases. The majority of patients affected by HA-BSI were infants (24/46; 52.2%), malnourished (50%) and HIV-uninfected (91.3%). The clinical impact of HA-BSI was severe, with 41% developing a new requirement for mechanical ventilation. K. pneumoniae, A. baumannii and Candida species were the most prevalent HA-BSI pathogens and exhibited substantial antimicrobial resistance. Patient outcomes were poor with a crude mortality rate of 41.3% and a median length of PICU stay of 15 days. Conclusion: Rates of HA-BSI were comparable to that reported from high-income country PICU’s, but most HA-BSI pathogens exhibited substantial antimicrobial resistance, similar to that reported from other LMIC PICUs.